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Sample records for analgesia preventiva con

  1. Analgesia preventiva y multimodal con ketamina y dipirona en mastectomía radical por cáncer de mama

    Directory of Open Access Journals (Sweden)

    Miladys Justo Hernández

    2015-11-01

    Full Text Available El dolor agudo es frecuente en los pacientes que requieren intervención quirúrgica; su tratamiento satisfactorio es uno de los retos más importantes, presentando ventajas la terapéutica multimodal y preventiva. Se realizó un estudio longitudinal, prospectivo en 22 pacientes, a los que se les practicó mastectomía radical por cáncer de mama, con el objetivo de describir el uso de la analgesia multimodal y preventiva con ketalar y dipirona en el manejo del dolor posoperatorio de estos pacientes. La técnica anestésica utilizada fue total intravenosa, con propofol y fentanyl, dosis convencional. En el postoperatorio se vigiló la aparición de efectos colaterales. Los datos se colocaron en tablas de contingencia, procesados mediante el sistema de cálculos estadísticos que presenta Microsoft Excel. El análisis se realizó fundamentalmente a través de medidas de resúmenes, porcentaje y media aritmética. Se concluyó que la analgesia multimodal preventiva con ketamina y dipirona fue efectiva y segura en todos los casos, a los que se realizó radical de mama. Predominó el grupo de edad entre 46 y 65 años y ASA II. Las variables hemodinámicas y respiratorias se mantuvieron estables en todos los pacientes. No necesitaron analgesia de rescate. La somnolencia se manifestó en 13,6% de los casos.

  2. Conservación preventiva de documentos fotográficos con valor patrimonial

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    Luis Ernesto Paz Enrique

    2017-07-01

    Full Text Available La conservación preventiva de documentos se centra en otorgar condiciones óptimas a las fuentes para evitar su deterioro. Se plantean como objetivos 1 identificar los principales factores que inciden en las colecciones fotográficas que atesora la Sala de Historia de la Universidad Central “Marta Abreu” de Las Villas y 2 diseñar un plan de medidas de conservación preventiva para los materiales fotográficos del centro mencionado. El estudio se caracterizó por seguir una perspectiva metodológica mixta con la aplicación de métodos en los niveles teórico y empírico. Se identificaron los principales factores de deterioro de las colecciones fotográficas de la Sala de Historia de la Universidad Central “Marta Abreu” de Las Villas. Se diseñó un plan de medidas de conservación preventiva a partir de las características de las fuentes y del diagnóstico realizado. Los materiales fotográficos presentan características distintivas del resto de los documentos. El diseño de planes de conservación preventiva debe estar centrado en los resultados obtenidos en los diagnósticos que se realicen a las colecciones. Se identifican las características de los materiales fotográficos. Se realiza un estudio de caso para caracterizar los factores de deterioro que inciden en las colecciones fotográficas de la Sala de Historia de la Universidad Central “Marta Abreu” de Las Villas. Se enuncian acciones para favorecer la conservación preventiva de los materiales fotográficos.

  3. Analgesia preemptiva nas cirurgias da coluna lombossacra: estudo prospectivo e randomizado Analgesia preventiva en las cirugías de la columna lumbosacra: estudio prospectivo y aleatorio Preemptive analgesia in lumbosacral spine surgeries: prospective randomized study

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    Augustin Malzac

    2009-06-01

    Full Text Available OBJETIVO: Analisar a eficácia da analgesia preemptiva pelo método da administração de analgésicos antes e após o início do estímulo doloroso operatório, comparando-as. A melhora do quadro doloroso pós-operatório nas cirurgias da coluna vertebral no segmento lombossacro, por via posterior, não tem sido completamente investigada. MÉTODOS: Sessenta e dois pacientes submetidos à microdiscectomia ou microdescompressão, em um único nível, na coluna lombossacra, foram divididos em três grupos, 20 pacientes no primeiro (A não receberam qualquer substância analgésica (controle. Vinte e dois no segundo (B, os quais foram submetidos à injeção epidural, 20 minutos antes da incisão cirúrgica, contendo 10 mL de marcaína e morfina. No terceiro e no último grupo (C com vinte pacientes, foi injetado, com auxílio de um cateter, no espaço epidural, as mesmas drogas do grupo B, através da incisão antes do fechamento da ferida operatória. Os pacientes foram examinados durante as primeiras 24 horas com auxílio da escala verbal de dor. RESULTADOS: Os três grupos foram comparados quanto à idade, sexo, nível e tempo cirúrgico. Os dados não obedeceram a uma distribuição Gaussiana, o teste não paramétrico de Mann-Whitney foi adotado para análise estatística. Desta maneira, os valores da escala verbal de dor, em todos os intervalos de tempo, foram significativamente baixos (pOBJETIVO: analizar la eficacia y comparar la analgesia preventiva por el método de la administración de analgésicos antes y después del inicio del estímulo doloroso operatorio. La mejoría del cuadro doloroso postoperatorio en las cirugías de la columna vertebral en el segmento lumbosacro, por vía posterior, no ha sido completamente investigada. MÉTODOS: sesenta y dos pacientes sometidos a la microdisección o microdescompresión, en un único nivel, en la columna lumbosacra fueron divididos en tres grupos. Veinte pacientes en el primer grupo (A no

  4. Medicina Preventiva

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    Alberto Hernandez Saenz

    1992-12-01

    Full Text Available

    “Lo que no se puede curar se debe prevenir”.

    El concepto actual de Medicina Preventiva debe estar orientado integralmente al conocimiento de: qué es lo que debemos prevenir que se afecte o sea la salud del hombre.

    Por eso día a día se amplían los profesiogramas integrados que promueven la Medicina Preventiva en todas sus áreas, e incorporan: juristas, administradores, ingenieros (sanitarios si es el caso, matemáticos, sociólogos, antropólogos, politólogos, economistas. Y claro está, los profesionales de medicina, odontología, enfermeras, promotores de salud, profesionales paramédicas. Estas incorporaciones y la suma de esfuerzos denodados, serán propicios para disminuir la carga de enfermedad sicofísica, que aflige al pueblo colombiano.

    Reflexionar sobre el servicio que cada uno de estos profesionales puede prestar en medidas de prevención de la salud es primordial. Su análisis simple de éste, el aspecto costo/beneficio es de una magnitud impresionante. Parodiando a W. Churchill podemos decir: “Nunca tan pocos hicieron tanto por muchos”.

    Por estos medios se logra una mayor participación de las familias y los individuos en los programas preventivos. Se ofrecen tecnologías adecuadas y científicamente fundadas. Conocer mejor los problemas de patología local y en esta forma adecuar mejores soluciones preventivas, dirigidas a las poblaciones de mayor riesgo, vg: niños, adolescentes, minusválidos y ancianos.

    Conformar un equipo participativo de médicos, odontólogos, enfermeras, auxiliares, trabajadores’ de la comunidad.

    Constituyen necesidades primordiales de prevención:

    1 Enfermedades inmunoprevenibles de la infancia, con vacunaciones masivas de cubrimiento nacional.
    2 Programas contra el Paludismo, TBC, EDA, IRA, Lepra, SIDA y otras enfermedades de transmisión sexual (E.T.S..
    3 Vacunación antirrábica.
    4 Diagnóstico precoz

  5. Mastoplastia reductora con analgesia acupuntural A mamaplastic reduction using acupunctural analgesia

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    Javier Cordero Lozano

    2004-08-01

    Full Text Available Se realizó un ensayo clínico prospectivo y descriptivo con 40 pacientes portadoras de hipertrofia mamaria que acudieron a consulta de Cirugía Plástica en el Hospital Universitario "Abel Santamaría Cuadrado" de Pinar del Río entre septiembre de 2002 y agosto de 2003 a las que se les realizó mastoplastia reductora con analgesia acupuntural (puntos C1, IG4, VC17, VG20 y un punto especial evaluando la calidad de la analgesia acupuntural transoperatoria, el comportamiento hemodinámico transoperatorio y la ocurrencia de complicaciones postoperatorias. Para la validación estadística se utilizó el paquete Systat Con nivel de ajuste µ= 0.05. Se logró con la acupuntura un nivel analgésico transoperatorio satisfactorio en el 50 % de los casos, incluyendo pacientes de todos los grupos de edad, sobre todo en intervenciones que duraran hasta dos horas, independientemente del grado de hipertrofia mamaria. El comportamiento hemodinámico transoperatorio fue satisfactorio en las pacientes operadas con acupuntura; con esta técnica el registro de complicaciones fue inferior al reportado con anestesia general endotraqueal por otros autores, sin que se reportaran reacciones adversas por el uso de la acupuntura.A prospective descriptive clinical trial was carried out in a sample of 40 patients suffering from breast hypertrophy who attended Cosmetic Surgery Office at Abel Santamaría General Hospital between September 2002 and August 2003. A reductive mastoplasia using acupunctural analgesia was carried out (C1, IG4, VC17, VG20 points and special one assessing the quality of transoperative acupunctural analgesia, transoperative hemodynamic behaviour and the occurrence of postoperative complications. Systat pack was used for statistical validation with a fitted level of a = 0.05. a transoperative analgesic level was achieved successfully in 50 % of cases including patients from every age group particularly in up to two hours surgeries irrespective of the

  6. Proyecto de atención preventiva de mujeres con alto riesgo reproductivo

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    A. Cardona Pérez

    2017-06-01

    El proyecto es una estrategia de mejora en la atención médica de las mujeres en edad reproductiva con enfermedades crónicas o sistémicas, que contempla dos direcciones fundamentales: 1 mejora de los servicios de salud, 2 mejora de la salud de la población. La implementación de este proyecto pretende contribuir en la reducción de la mortalidad materna por causa indirecta, y a través de esta estrategia reducir las brechas existentes en las condiciones de salud entre la población de nuestro país.

  7. La prevención del VIH/SIDA en el colectivo de hombres que mantienen relaciones sexuales con hombres (HSH): Ejemplos de intervenciones preventivas individuales, grupales y comunitarias

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    María Jesús Martín; Daniela Rojas; José Manuel Martínez; José Miguel Sánchez; Eduardo Remor; Jorge del Romero

    2008-01-01

    El objetivo de este estudio es describir y sistematizar distintas intervenciones preventivas realizadas para controlar la propagación del virus de inmunodeficiencia humana (VIH) en el colectivo de hombres que practican sexo con hombres (HSH). Dichas intervenciones, centradas en el cambio de la conducta sexual de riesgo asociada a la transmisión del virus, han sido clasificadas en individuales, grupales y comunitarias, según su nivel de implantación. De cada una se describen los destinatarios,...

  8. Pro con debate: the use of regional vs systemic analgesia for neonatal surgery.

    Science.gov (United States)

    Bösenberg, Adrian T; Jöhr, Martin; Wolf, Andrew R

    2011-12-01

    In recent years the inclusion of regional techniques to pediatric anesthesia has transformed practice. Simple procedures such as caudal anesthesia with local anaesthetics can reduce the amounts of general anesthesia required and provide complete analgesia in the postoperative period while avoiding large amounts of opioid analgesia with potential side effects that can impair recovery. However, the application of central blocks (epidural and spinal local anesthesia) via catheters in the younger infant, neonate and even preterm neonate remains more controversial. The potential for such invasive maneuvers themselves to augment risk, can be argued to outweigh the benefits, others would argue that epidural analgesia can reduce the need for postoperative ventilation and that this not only facilitates surgery when intensive care facilities are limited, but also reduces cost in terms of PICU stay and recovery profile. Currently, opinions are divided and strongly held with some major units adopting this approach widely and others maintaining a more conservative stance to anesthesia for major neonatal surgery. In this pro-con debate the evidence base is examined, supplemented with expert opinion to try to provide a balanced overall view. © 2011 Blackwell Publishing Ltd.

  9. Analgesia postoperatoria con catéter incisional en cesáreas electivas

    OpenAIRE

    Rodríguez Morejón, María del Carmen

    2012-01-01

    La cesárea supone hoy en día una de las intervenciones quirúrgicas obstétricas más frecuentes. A esto se añade que la cesárea está dentro del grupo de intervenciones con un dolor postoperatorio de intensidad elevada y que ninguna opción analgésica ha demostrado ser la mejor. Por ello se diseñó un estudio de intervención, prospectivo, aleatorizado, no ciego, para comparar la eficacia, en el control del dolor tras la cesárea (medido mediante Escala Visual Analógica), de la analgesia incision...

  10. La prevención del VIH/SIDA en el colectivo de hombres que mantienen relaciones sexuales con hombres (HSH: Ejemplos de intervenciones preventivas individuales, grupales y comunitarias

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    María Jesús Martín

    2008-01-01

    Full Text Available El objetivo de este estudio es describir y sistematizar distintas intervenciones preventivas realizadas para controlar la propagación del virus de inmunodeficiencia humana (VIH en el colectivo de hombres que practican sexo con hombres (HSH. Dichas intervenciones, centradas en el cambio de la conducta sexual de riesgo asociada a la transmisión del virus, han sido clasificadas en individuales, grupales y comunitarias, según su nivel de implantación. De cada una se describen los destinatarios, acciones y principales resultados. Se pretende así establecer unas breves conclusiones sobre las ventajas e inconvenientes de su utilización en función de variables personales, sociales, ambientales, etc. Los resultados permiten concluir que los intentos de prevención del VIH/SIDA, al menos en el colectivo HSH, deben considerar la necesidad de que intervenciones individuales y grupales se combinen con intervenciones comunitarias.

  11. Enfermeiros com cargos de chefia e medidas preventivas à exposição ocupacional: facilidades e barreiras Enfermeros con cargos de jefe y medidas preventivas a la exposición ocupacional: facilidades y barreras Nurses in leading positions and measures to prevent occupational exposure: facilities and barriers

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    Silmara Elaine Malaguti

    2008-09-01

    Full Text Available Este estudo descritivo teve como objetivo avaliar as facilidades e barreiras enfrentadas por enfermeiros com cargo de chefia quanto às medidas preventivas à exposição ocupacional envolvendo material biológico, tendo como base o Modelo de Crenças em Saúde de Rosenstock. O estudo foi realizado com 87 enfermeiros de um hospital-escola do interior paulista em 2006. Os dados foram coletados através de um roteiro semi-estruturado, com questões abertas e fechadas e analisados pela técnica de Análise de Conteúdo. O equipamento de proteção individual foi citado como a maior facilidade para a prevenção de acidentes, porém a falta de adesão ao uso e o uso incorreto foram referidos como barreiras para a prevenção de acidentes e como os principais motivos para a ocorrência destes. É importante que estes enfermeiros estejam preparados para desenvolver estratégias individualizadas e motivadoras para adesão ao uso do equipamento de proteção individual em seus setores de trabalho.En este estudio descriptivo se tuvo como objetivo evaluar las facilidades y barreras enfrentadas por enfermeros con cargo de jefe en cuanto a las medidas preventivas a la exposición ocupacional que involucre material biológico, teniendo como base el Modelo de Creencias en Salud de Rosenstock. El estudio fue realizado con 87 enfermeros de un hospital escuela del interior de Sao Paulo, en el 2006. Los datos fueron recolectados a través de una guía de entrevista semi-estructurada, con preguntas abiertas y cerradas y analizados con la técnica del Análisis de Contenido. El equipamiento de protección individual fue citado como la mayor facilidad para la prevención de accidentes, no obstante la falta de adhesión al uso y uso incorrecto fueron referidos como barreras para la prevención de accidentes y como los principales motivos para que éstos ocurran. Es importante que estos enfermeros estén preparados para desarrollar estrategias individualizadas y

  12. Historia de la Conservación Preventiva. Parte II

    OpenAIRE

    García Fernández, Isabel M.

    2014-01-01

    La segunda parte de la historia de la conservación preventiva comienza en 1990; esta etapa es mucho más corta que la primera,pero más prolífica en materiales, proyectos y publicaciones. Vamos a ver cómo desde sus inicios, la conservación preventiva ha ido cobrando protagonismo en todos los ámbitos relacionados con la preservación y uso del patrimonio. En este artículo vamos a destacar los hitos fundamentales que han conseguido afianzar esta disciplina en los últimos 25 años y valorar- su desa...

  13. Premedicación con clonidina para la analgesia posoperatoria en niños

    Directory of Open Access Journals (Sweden)

    2014-07-01

    Conclusiones de los autores: Hubo sólo 11 ensayos relevantes que estudiaron a 742 niños con cirugía en los que la premedicación con clonidina se comparó con el placebo u otra farmacoterapia. A pesar de la heterogeneidad entre los ensayos, la premedicación con clonidina en una dosificación adecuada (4 μg/ kg tuvo un efecto beneficioso para el dolor posoperatorio en niños. Los efectos secundarios fueron mínimos, pero algunos de los estudios usaron la atropina como profilaxis con la intención de prevenir la bradicardia y la hipotensión. Se requiere más investigación para determinar en qué condiciones la premedicación con clonidina es más efectiva en el alivio del dolor posoperatorio en niños.

  14. Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso Analgesia de parto en paciente con tetralogía de Fallot no corregida: relato de caso Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

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    Florentino Fernandes Mendes

    2005-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a tetralogia de Fallot seja a mais comum das cardiopatias congênitas cianóticas, as publicações nacionais, relacionando essa doença com a prática anestésica são escassas. O objetivo deste relato é apresentar um caso de analgesia de parto em paciente portadora de tetralogia de Fallot não corrigida e diagnosticada durante a gestação. RELATO DO CASO: Paciente com 26 anos, 56 kg, 1,56 m, idade gestacional 32 semanas e 5 dias, com diagnóstico de tetralogia de Fallot realizado durante a gestação. Internou em trabalho de parto. A conduta obstétrica foi a de parto via baixa, sendo realizada analgesia através de bloqueio peridural com bupivacaína a 0,125% e fentanil (100 µg e colocação de cateter peridural. Após 1h30 minutos do início da analgesia, ocorreu o nascimento. O peso do recém-nascido foi 1485 g e o índice de Apgar 6 e 8 no primeiro e no quinto minutos, respectivamente. A paciente permaneceu estável e sem alterações hemodinâmicas e/ou eletrocardiográficas. CONCLUSÕES: A escolha da técnica anestésica é de fundamental importância no manuseio das pacientes com tetralogia de Fallot não corrigidas. Condições favoráveis do colo e boa dinâmica uterina, particularmente naquelas pacientes sem história de síncope, tornam-se imprescindíveis para uma boa indicação da analgesia de parto.JUSTIFICATIVA Y OBJETIVOS: Aunque la tetralogía de Fallot sea la más común de las cardiopatías congénitas cianóticas, las publicaciones nacionales, relacionando esa enfermedad con la práctica anestésica son escasas. El objetivo de este relato es presentar un caso de analgesia de parto en paciente portadora de tetralogía de Fallot no corregida y diagnosticada durante la gestación. RELATO DEL CASO: Paciente con 26 años, 56 kg, 1,56 m, edad gestacional 32 semanas y 5 días, con diagnóstico de tetralogía de Fallot realizado durante la gestación. Internó en trabajo de parto. La conducta

  15. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

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    Neuber Martins Fonseca

    2003-04-01

    perivascular inguinal, llamado de bloqueo 3 en 1, ha sido utilizado para analgesia pós-operatoria. El objetivo de este estudio fue comparar la analgesia pós-operatoria del bloqueo 3 en 1 a la de la morfina subaracnóidea en pacientes sometidos a cirugías ortopédicas en miembro inferior (MI. MÉTODO: Fueron estudiados 40 pacientes escalados para cirugía ortopédica de MI, de ambos sexos, estado físico ASA I y II, con edades entre 15 y 75 años, distribuidos en 2 grupos (M y BPL. Fue realizada anestesia subaracnóidea en todos los pacientes, en L3-L4 ó L4-L5, con 20 mg de bupivacaína isobárica a 0,5%. En el grupo M (n = 20 fue asociado 50 µg de morfina al anestésico local. En el grupo BPL (n = 20 fue realizado el bloqueo 3 en 1 al término de la cirugía, utilizando 200 mg de ropivacaína a 0,5%. Se evaluó la analgesia y la intensidad del dolor a las 4, 8, 12, 14, 16, 20 y 24 horas después del término de la cirugía, el nivel del bloqueo subaracnóideo, el tiempo quirúrgico y las complicaciones. RESULTADOS: La duración de la analgesia en el grupo BPL fue de 13,1 ± 2,47, en cuanto en el grupo M todos los pacientes referían dolor y ausencia de bloqueo motor en el primero instante evaluado (4 horas. Hubo falla del bloqueo de uno de los 3 nervios en 3 pacientes. La incidencia de náusea y prurito fue significativamente mayor en el grupo M. Cuanto a la retención urinaria, no hubo diferencia significante entre los grupos. No hubo depresión respiratoria, hipotensión arterial o bradicardia. La analgesia pós-operatoria fue mas efectiva en el grupo BPL, comparada al grupo M a las 4, 8, 12,14 y 16 horas. A las 20 y 24 horas no hubo diferencia significante entre los grupos.BACKGROUND AND OBJECTIVES: Perivascular Lumbar plexus inguinal block, (3-in-1 block has been used for postoperative analgesia. This study aimed at comparing postoperative analgesia of 3-in-1 block and spinal morphine in patients submitted to lower limb orthopedic surgeries (LL. METHODS: Forty ASA I

  16. EFECTOS PSÍQUICOS DE LA MASTECTOMÍA (PREVENTIVA Y TERAPÉUTICA. CAMBIOS EN LA PERCEPCIÓN DE LAS MUJERES CON CÁNCER DE MAMA

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    Teresa Sánchez Sánchez

    2015-01-01

    Full Text Available ¿Qué sentido puede tener escribir un trabajo más -dada la abundante literatura específica sobre ello-, que analice las consecuencias de la mastectomía en mujeres que o bien han sido diagnosticadas previamente de un cáncer de mama o bien tienen un fundado temor genético a desarrollarlo en un futuro indeterminado a tenor de los antecedentes familiares que poseen? Repasaremos algunos trabajos destacados sobre el impacto en el psiquismo de la mastectomía (sea ésta como forma de prevención secundaria frente al cáncer o sea profiláctica en comparación con la llamada “cirugía conservadora” (lumpectomía, tumorectomía, a fin de valorar el consenso o el disenso entre los investigadores. Nuestra hipótesis de trabajo es que se ha producido en las pacientes con cáncer de mama un cambio de tendencia en su perspectiva de la mastectomía coincidente con el cambio de siglo (y milenio, tal vez debido a la generalización de la cirugía reconstructiva mamaria tras la resección, lo que mitiga el alcance traumático (imaginario, simbólico y físico de la amputación sin reconstrucción.

  17. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive analgesia is still...

  18. Socialización preventiva en las Comunidades de Aprendizaje

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    Ainhoa Flecha

    2010-01-01

    Full Text Available Este artículo examina las características específicas de las Comunidades de Aprendizaje que pueden contribuir a la superación de la violencia de género. En primer lugar, examinamos las aportaciones del feminismo dialógico que están articulando formas de solidaridad femenina orientadas a la prevención y superación de la violencia de género en las escuelas. En segundo lugar, examinamos las contribuciones en torno a las nuevas masculinidades y su impacto en la lucha contra esta problemática. Finalmente, se desarrolla la aportación que representa la socialización preventiva en el trabajo que se está haciendo con niños, niñas y adolescentes en las Comunidades de Aprendizaje.

  19. Intervención preventiva en lugares de interacción social de hombres que mantienen relaciones sexuales con otros hombres Preventive intervention in venues for interaction used by men who have sex with men

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    Isabel Hurtado

    2010-01-01

    Full Text Available Se realizó una intervención en saunas y pisos para contactos sexuales entre hombres que mantienen relaciones sexuales con hombres de Valencia, cuyo objetivo era prevenir la infección por el virus de la inmunodeficiencia humana (VIH o, en su caso, evitar el retraso en el diagnóstico y facilitar el contacto con los circuitos sanitarios. Se proporcionó información sobre prevención y se efectuó la prueba rápida para el VIH y la sífilis. Se habló con 500 hombres y se realizó la intervención en 171. El 37% de los sujetos en las saunas y de cada en los pisos nunca se había realizado una prueba. La prevalencia del VIH fue del 1,6% (n=2 en las saunas y del 11% en los pisos (n=5; para la sífilis estos porcentajes fueron del 5 y el 2,3%, respectivamente. La intervención permitió detectar la existencia de bolsas de población poco atendidas y muy expuestas, y facilitó el acceso de estos sujetos al sistema sanitario.An intervention in venues for interaction used by men who have sex with men in Valencia (Spain was performed to prevent human immunodeficiency virus (HIV infection or avoid delay in diagnosis and to facilitate contact with the health circuit. Information was provided on prevention and a rapid test for HIV and syphilis was performed. We contacted 500 men and the intervention was performed in 171; 37% of the subjects in saunas and one in four of those in prostitution apartments had never been tested. The prevalence of HIV was 1.6% (n=2 in the saunas, and 11% (n=5 in the apartments (n=5. For syphilis, these percentages were 5% and 2.3% respectively. The intervention revealed the existence of highly exposed population groups with low compliance and facilitated access to the health system in these groups.

  20. Analgesia preemptiva com S(+cetamina e bupivacaína peridural em histerectomia abdominal Analgesia preemptiva con S(+cetamina y bupivacaína peridural en histerectomía abdominal Preemptive analgesia with epidural bupivacaine and S(+ketamine in abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Ferdinand Edson de Castro

    2005-02-01

    utilizadas em histerectomia abdominal.JUSTIFICATIVA Y OBJETIVOS: El presente estudio investiga la capacidad del antagonista del receptor NMDA, S(+cetamina, asociado a la inyección peridural de anestésico local (bupivacaína en promover analgesia preemptiva en pacientes sometidas a histerectomía total abdominal, administrando esa solución antepasadamente a la incisión. MÉTODO: Fueron evaluadas 30 pacientes, distribuidas aleatoriamente en dos grupos de igual tamaño y estudiadas prospectivamente de forma encubierta. Inyección peridural e inserción de catéter fueron realizadas entre los interespacios de L1-L2. En el grupo I (G1, n = 15, las pacientes recibieron por vía peridural, 17 mL de bupivacaína a 0,25% sin vasoconstrictor asociados a 30 mg de S(+cetamina (3 mL treinta minutos antes de la incisión quirúrgica y, después de 30 minutos de la incisión, recibieron 20 mL de solución fisiológica a 0,9%. En el grupo 2 (G2, n = 15, recibieron 20 mL de solución fisiológica por vía peridural, 30 minutos antes de la incisión, fue hecha una administración de 17 mL de bupivacaína a 0,25% asociadas a 30 mg de S(+cetamina (3 mL, treinta minutos después de la incisión. Después de la inyección peridural, se realizó anestesia general con propofol, pancuronio, O2 e isoflurano. Para analgesia post-operatoria fue usada solución peridural en bolus de fentanil asociada a la bupivacaína, con intervalo mínimo de cuatro horas. La suplementación con dipirona solamente era usada si necesario. Se evaluó la intensidad del dolor a través de escala numérica y verbal (al despertar, 6, 12, 18 24 horas después del término de la operación, el tiempo necesario para pedir por la primera vez el analgésico y el consumo total de analgésicos. RESULTADOS: No hubo diferencia significativa entre los grupos con relación al tiempo para pedir analgésicos por la primera vez, al consumo de analgésicos y a los resultados de dolor por las escalas numérica y verbal. CONCLUSIONES: No

  1. SE ENCUENTRA VIGENTE LA DETENCIÓN PREVENTIVA ADMINISTRATIVA? (CAPTURA ADMINISTRATIVA

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    Saúl de Jesús Uribe García

    2011-01-01

    Full Text Available La libertad personal es un derecho fundamental, no absoluto, puesto que puede limitarse con sujeción estricta a los requisitos constitucionales y legales. El derecho a la libertad personal puede limitarse por orden de autoridad judicial competente, y para esos efectos, la autoridad judicial competente es el juez con función de control de garantías, el juez de conocimiento o de maneraexcepcional la Fiscalía General de la Nación. La flagrancia es una excepción a esa orden de autoridad judicial competente para limitar la libertad personal, pero en el artículo 28, inciso segundo de la Constitución Política, existe la llamada Detención Preventiva Administrativa, cuyos lineamientos para su aplicación, fueron trazados por la Corte Constitucional, sin que se requiriera orden de autoridad judicial competente para privar de la libertad personal a una persona. Posteriormente, con la vigencia del Sistema Penal de corte Acusatorio, dicha figura fue cuestionada y se tornó dudosa su aplicación conforme los lineamientos trazados por la Corte Constitucional.Posteriormente, la Corte Constitucional retoma el tema de la Detención Preventiva Administrativa, retira del ordenamiento jurídico la interpretación anterior y concluye que la Detención preventiva Administrativa procede siempre que exista orden de captura proferida por una autoridad judicial competente. Posteriormente, la Corte Suprema de Justicia, Sala de Casación Penal, en algunas decisiones de habeas corpus, parece revivir la figura de la Detención Preventiva Administrativa.

  2. Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial Analgesia pos-operatoria con bloqueo bilateral del nervio pudendo con bupivacaína S75:R25 a 0,25%: estudio piloto en hemorroidectomia bajo régimen ambulatorial Bilateral pudendal nerves block for postoperative analgesia with 0.25% S75:R25 bupivacaine: pilot study on outpatient hemorrhoidectomy

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    Luiz Eduardo Imbelloni

    2005-12-01

    permitirão demonstrar se esta técnica deve ser a primeira opção para analgesia em hemorroidectomias. A permanência de anestesia perineal por 20,21 horas deverá induzir novos trabalhos com o bloqueio dos nervos pudendos orientado por estimulador para o ato cirúrgico.JUSTIFICATIVA Y OBJETIVOS: La hemorroidectomia puede ser realizada bajo varias técnicas anestésicas y en régimen ambulatorial. El dolor pos-operatorio es intenso y puede atrasar el retorno para el hogar. El objetivo de este estudio fue evaluar las ventajas y la realización del bloqueo bilateral de los nervios pudendos para analgesia pos-operatoria en hemorroidectomias. MÉTODO: El bloqueo bilateral de los nervios pudendos con bupivacaína S75:R25 a 0,25% fue realizado con estimulador de nervios en 35 pacientes sometidos a la hemorroidectomia bajo raquianestesia. Fueron evaluadas intensidad del dolor, duración de la analgesia, analgesia de demanda y eventuales complicaciones relacionadas a la técnica. Los datos fueron evaluados a las 6, 12, 18, 24 y 30 horas después del término de la intervención quirúrgica. RESULTADOS: En todos los pacientes, fue logrado éxito con la estimulación de ambos los nervios pudendos. En ningún momento de la evaluación ocurrió dolor intenso. Hasta 12 horas después del bloqueo, todos los pacientes presentaron anestesia en la región perineal; con 18 horas, 17 pacientes y 24 horas, 10 pacientes A analgesia pos-operatoria fue óptima en 18 pacientes; satisfactoria, en cinco pacientes; e insatisfactoria, en siete pacientes. La duración media de la analgesia fue de 23,77 horas. No ocurrieron alteraciones de la presión arterial, de la frecuencia cardiaca, ni fueron observados náuseas o vómitos. Todos los pacientes tuvieron micción espontánea. Ninguna complicación local o sistémica fue relacionada al anestésico local. Veintisiete pacientes clasificaron de excelente la técnica de analgesia y apenas tres pacientes del sexo masculino quedaron satisfechos

  3. Rabbit analgesia.

    Science.gov (United States)

    Barter, Linda S

    2011-01-01

    With the increasing popularity of rabbits as household pets, the complexity of diagnostic and surgical procedures performed on rabbits is increasing, along with the frequency of routine surgical procedures. More practitioners are faced with the need to provide adequate analgesia for this species. Preemptive analgesia prior to planned surgical interventions may reduce nervous system changes in response to noxious input, as well as reduce postoperative pain levels and analgesic drug requirements. Concurrent administration of analgesic drugs to anesthetized rabbits undergoing painful procedures is warranted both pre- and intraoperatively as well as postoperatively. This article discusses the neuropharmacologic and pharmacologic aspects of pain in rabbits, and reviews current protocols for the use of analgesic drugs. Published by Elsevier Inc.

  4. Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico El bloqueo selectivo de los nervios supraescapular y axilar promueve una analgesia satisfactoria y un menor grado de bloqueo motor: comparación con el bloqueo interescalénico Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

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    Patrícia Falcão Pitombo

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI e grupo seletivo (GS, sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.JUSTIFICATIVA Y OBJETIVOS: Las cirugías artroscópicas del hombro cursan con un intenso dolor postoperatorio. Diversas técnicas analgésicas han sido preconizadas

  5. Inmoralidad de la prisión preventiva

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    Jorge W. Álvarez

    2014-11-01

    Full Text Available El título no me pertenece; por eso lo pongo entre comillas, corno corresponde en rigor gramatical. Lo torné prestado de un precioso trabajo del maestro pisano Francesco Carrara, recién aparecido en una revista de criminología y que manos dilectas pusieron en las mías, conociendo mi vieja pasión por el tema. Y me dije, esto tiene que conocerse por todos los medios posibles para que la voz del viejo maestro resuene con potencia renovada.He aquí, estimado lector, el propósito de esta glosa que hoy pongo a tu consideración.No es el momento ni tampoco tendría mayor interés hacer la historia de la prisión preventiva en este país. Más vale olvidarla por todo lo que tuvo de aborrecible y antijurídica.Sólo cabría apuntar que esa historia, en términos generales, quedó dividida en dos tramos a partir de la sanción de la Ley 15.859 del 31 de marzo de 1987 y por la cual su aplicación se redujo a circunstancias excepcionales, muy pocas por cierto.

  6. LAS MEDIDAS PREVENTIVAS AMBIENTALES, UNA APROXIMACIÓN DESDE EL DERECHO ADMINISTRATIVO.

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    Iván Andrés Páez Páez

    2013-05-01

    Full Text Available Las medidas preventivas previstas en el régimen sancionatorio ambiental sonuna especie de las medidas cautelares consagradas en el ordenamiento jurídicocolombiano, aunque con algunas particularidades propias de su ámbito deaplicación, que es el derecho ambiental. El artículo realiza una aproximaciónrespecto al contenido, alcance, antecedentes y justificación de las medidaspreventivas ambientales desde la óptica del derecho administrativo y comomanifestación de una de las funciones del ejecutivo, cual es el mantenimientodel orden público.

  7. Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo Analgesia controlada por el paciente con fentanil o sufentanil en el pós-operatorio de reconstrucción de ligamentos de la rodilla: estudio comparativo Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

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    Marcelo Negrão Lutti

    2002-04-01

    diferença entre os grupos. CONCLUSÕES: O fentanil ou o sufentanil contínuos em bolus acionados pelo paciente, por via peridural, nas doses utilizadas neste estudo, apresentaram excelente analgesia pós-operatória. No entanto, o sufentanil apresentou efeitos colaterais mais intensos que o fentanil.JUSTIFICATIVA Y OBJETIVOS: Los opioides han sido utilizados por vía peridural asociados o no a anestésicos locales para analgesia pós-operatoria de forma continua y/o en bolus controlado por el paciente. El objetivo de este estudio fue comparar la analgesia pós-operatoria entre el fentanil y sufentanil en infusión continua y en bolus por vía peridural, en pacientes sometidos a la reconstrucción de ligamento de la rodilla. MÉTODO: Participaron del estudio 70 pacientes con edad entre 16 y 47 anos, estado físico ASA I y II, divididos aleatoriamente en dos grupos: Grupo F (fentanil y Grupo S (sufentanil. Todos los pacientes fueron sometidos a anestesia peridural con bupivacaína a 0,5% (100 mg con epinefrina 1:200.000 asociada a fentanil (100 mg. Al final de la cirugía, los pacientes recibieron fentanil (Grupo F o sufentanil (Grupo S por vía peridural en régimen de infusión continua más bolus liberados por el paciente. En el Grupo F fue utilizada solución fisiológica (85 ml conteniendo fentanil 500 µg (10 ml y bupivacaína (5 ml a 0,5%. En el Grupo S fue utilizada solución fisiológica (92 ml conteniendo sufentanil 150 µg (3 ml y bupivacaína (5 ml a 0,5%. Para los dos grupos la bomba de infusión fue programada inicialmente en 5 ml.h-1, con dosis de 2 ml en bolus liberado por el paciente en un intervalo de 15 minutos. Fueron comparados los siguientes parámetros: dolor, número de bolus accionados, consumo de opioides, bloqueo motor, sedación y efectos colaterales. RESULTADOS: No hubo diferencia significativa entre los grupos cuanto la calidad de la analgesia, siendo la mayoría de buena calidad (EAV 0 a 2. Hubo diferencia significativa cuanto al número de

  8. Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína Comparación entre tres técnicas regionales de analgesia postoperatoria en niños con ropivacaina Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

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    Ana Maria Menezes Caetano

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória acarreta um aumento nos gastos e gera insatisfação dos pais com relação à prescrição analgésica para os seus filhos. A ropivacaína apresenta larga margem de segurança em anestesia regional em pediatria. O objetivo deste estudo foi comparar a anestesia peridural sacra (PS com o bloqueio dos nervos ileoinguinal/ileohipogástrico (BIHII e com a infiltração da ferida operatória (IFO utilizando a ropivacaína para a analgesia pós-operatória em crianças. MÉTODO: Foram estudadas 87 crianças do sexo masculino, com idade entre 1 e 5 anos, submetidas a herniorrafias inguinais eletivas unilaterais. As crianças receberam de forma aleatória a PS, o BIHII ou a IFO. Pesquisou-se a necessidade de analgésico no pós-operatório, o tempo necessário para a sua 1ª dose, a intensidade da dor e o grau de bloqueio motor. RESULTADOS: No Grupo da IFO observou-se maior necessidade de analgésicos, e maior intensidade de dor nas primeiras duas horas, quando comparada com a PS e com o BIHII. Apenas crianças submetidas a PS apresentaram bloqueio motor de grau leve. O tempo médio da necessidade da 1ª dose de analgésico foi semelhante entre os grupos. CONCLUSÕES: O BIHII apresentou superioridade sobre a IFO, sobretudo nas primeiras duas horas de pós-operatório. As três técnicas anestésicas podem ser utilizadas com segurança e eficácia no controle da dor pós-operatória de herniorrafia inguinal em crianças.JUSTIFICATIVA Y OBJETIVOS: El dolor postoperatorio acarrea un aumento en los gastos y genera una insatisfacción de los padres en relación a la prescripción analgésica para sus hijos. La ropivacaína presenta un amplio margen de seguridad en anestesia regional en pediatría. El objetivo de este estudio fue el de comparar la anestesia peridural sacra (PS con el bloqueo de los nervios ileoinguinal/ileohipogástrico (BIHII y con la infiltración de la herida operatoria (IFO utilizando la

  9. Fomentar la cultura preventiva entre trabajadores y empresarios

    Directory of Open Access Journals (Sweden)

    José Manuel González Tizón

    2013-01-01

    Full Text Available Desde hace más de una década, la entidad trabaja activamente en la puesta en marcha de acciones preventivas que mejoren las condiciones de seguridad y salud de los trabajadores y empresarios de la zona.

  10. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

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    Daniel Espada Lahoz

    2003-09-01

    melhorou a qualidade do bloqueio quanto à motilidade do músculo reto medial e diminuiu a necessidade de analgésicos no pós-operatório.JUSTIFICATIVA Y OBJETIVOS: La anestesia locorregional para cirugías oftalmológicas ofrece ventajas, como: mínimas alteraciones fisiológicas, anestesia completa, bloqueo de los reflejos oculares, pequeña incidencia de náuseas y vómitos, menor tiempo de recuperación y analgesia pos-operatoria. La preocupación constante con la calidad del bloqueo, así como la abordaje de la analgesia pos-operatoria debe quedar bajo la responsabilidad del anestesiologista. El objetivo de este estudio fue evaluar si el fentanil contribuye en la calidad del bloqueo extraconal y en la analgesia pos-operatoria de facectomias con implantación de lente intra-ocular. MÉTODO: Se estudió la asociación del fentanil y bupivacaína a 0,75% en la calidad del bloqueo ocular y en la analgesia pos-operatoria en 164 pacientes sometidos a facectomia con implantación de lente intra-ocular (técnica extracapsular, de ambos sexos con homogeneidad de parámetros antropométricos, ojo operado, clasificación del estado físico (ASA e índice de riesgo cardíaco de Goldman. Los pacientes fueron distribuidos en dos grupos (82 pacientes en cada grupo por sorteo de forma aleatoria, con y sin fentanil. Se evaluó la calidad del bloqueo por: aparecimiento de dolor en el per-operatorio, manutención de movimentación de los párpados o del globo ocular, persistencia del reflejo de Bell, número de bloqueos realizados para la obtención de condiciones quirúrgicas y evaluación del bloqueo por el cirujano. La analgesia pos-operatoria fue evaluada por la necesidad de complementación analgésica por el paciente. RESULTADOS: Fentanil asociado a la solución anestésica en el bloqueo extraconal aumentó significativamente el bloqueo del músculo recto medial (con fentanil - 17,1%, sin fentanil - 32,9% y diminuyó el consumo de analgésicos en el período pos-operatorio (uso

  11. Seguridad Vial y Procesos Psicológicos: Acciones Preventivas. [ Road Safety and Psychological Processes: Preventive Actions

    OpenAIRE

    Manuel Ernesto Riaño Garzón; Nathalie Claire Raynaud Prado; Edgar Alexis Diaz Camargo

    2017-01-01

    El artículo revisa la relación entre los procesos psicológicos y la seguridad vial desde una postura preventiva con el fin de proporcionar evidencias sobre alternativas utilizadas en terapia que puedan ser de utilidad para el adecuado funcionamiento psico-fisiológico y que determinen una mayor Seguridad Vial. Dicha revisión resulta pertinente en el marco de la Policía Nacional y de la Seguridad Vial en tanto ilustra metodologías empíricamente validadas que pueden ser utilizadas por las person...

  12. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

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    Nilton Bezerra do Vale

    2006-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a dor aguda e a crônica sejam habitualmente controladas com intervenções farmacológicas, 14 métodos complementares de analgesia adjuvante e alternativa (AAA podem reduzir o uso e abuso na prescrição de analgésicos e diminuir os efeitos colaterais que eventualmente comprometem o estado fisiológico do paciente. CONTEÚDO: Todos os mecanismos antiálgicos atuam através da via espinal de controle da comporta de Melzack e Wall e/ou através da transdução do sinal nos sistemas de neurotransmissão e neuromodulação central relacionados com analgesia, relaxamento e humor: peptidérgico, monaminérgico, gabaérgico, colinérgico e canabinóide. A analgesia adjuvante complementar é habitualmente utilizada nos tratamentos fisiátricos, ortopédicos, reumatológicos, obstétricos e com acupuntura. A analgesia alternativa complementar pode potencializar os métodos analgésicos convencionais, a exposição à luz do sol matutino, luz e cores sob luz artificial, o tempo (T - anestésicos gerais mais potentes à noite, opióides de manhã e anestésicos locais à tarde, dieta, bom humor e riso, espiritualidade, religião, meditação, musicoterapia, hipnose e efeito placebo. CONCLUSÕES: Se a dor aguda é um mecanismo de defesa, a dor crônica é um estado patológico desagradável relacionado com a depressão endógena e a uma baixa qualidade de vida. É importante estabelecer relações interdisciplinares entre a Medicina adjuvante e alternativa nas terapias analgésicas e antiinflamatórias clássicas.JUSTIFICACIÓN Y OBJETIVOS: Aunque el dolor agudo y el crónico sean habitualmente controlados con intervenciones farmacológicas, 14 métodos complementarios de analgesia adyuvante y alternativa (AAA pueden reducir el uso y el abuso en la prescripción de analgésicos y disminuir los efectos colaterales que eventualmente comprometen el estado fisiológico del paciente. CONTENIDO: Todos los mecanismos anti

  13. SESAMO: UN ESTUDIO SOBRE LOS DISCURSOS LEGITIMANTES DE LA PRISIÓN PREVENTIVA Y UN ANÁLISIS SOBRE SU CONSTITUCIONALIDAD

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    Jonathan Ariel Polansky

    2015-09-01

    Full Text Available Motivado por el alarmante número de personas que se encuentran privadas de su libertad sin contar con una sentencia condenatoria efectiva, este trabajo tiene por objeto realizar un análisis de los discursos que tienden a legitimar la posibilidad de aplicación del instituto de la prisión preventiva, a fin de determinar si sus formulaciones son respetuosas de las garantías constitucionales que deben observarse en el proceso penal.

  14. A assistência preventiva do enfermeiro ao trabalhador de enfermagem La asistencia preventiva de la enfermera al trabajador de enfermería Nurse's preventive attendance to the nursing worker

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    Ana Lúcia de Almeida Campos

    2005-08-01

    Full Text Available A temática do presente estudo surgiu da experiência que temos em nossa prática profissional, onde pudemos observar o absenteísmo dos profissionais de enfermagem decorrentes de doenças relacionadas ao trabalho, o que nos despertou o interesse em nos aprofundar no papel do enfermeiro nas ações preventivas relacionadas à saúde do trabalhador de enfermagem em sua trajetória profissional comparando-as com as Normas Regulamentadoras. As ações preventivas em saúde do trabalhador é uma busca constante, que necessita de mais investimento com o objetivo de melhorar as condições de trabalho, proporcionando um ambiente saudável.El tema del estudio presente resulta de la experiencia que nosotros tenemos en nuestra práctica profesional dónde nosotros podríamos observar el ausentismo de los profesionales relacionado com enfermedades, lo que se nos despertó el interés ahondándonos en el papel de la enfermera en las acciones preventivas relacionó a la salud del trabajador de enfermería en su camino profesional comparandolas con la Norma Regulatoria. Las acciones preventivas en la salud del trabajador son una búsqueda constant, que necesita más inversión con el objetivo de mejorar las condiciones de trabajo, mientras proporcionando una atmósfera saludable.The theme of the present study emerged from the experience that we have in our professional practice, where we could observe the absenteeism of nursing professionals related to diseases, what woke up us the interest in deepening in the nurse's paper in the preventive actions related to the nursing worker's health in his/her professional path comparing them with the Regulatory Norms. The preventive actions in the worker's health is a constant search, that needs more investment with the objective of improving the work conditions, providing a healthy atmosphere.

  15. Procedural sedation analgesia

    OpenAIRE

    Sheta, Saad A

    2010-01-01

    The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interve...

  16. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-06-01

    diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in

  17. A experiência de uma prática preventiva com adolescentes em situação de risco La experiencia de una práctica de prevención con adolescentes en riesgo The experience of a preventive practice with adolescents at risk

    Directory of Open Access Journals (Sweden)

    Paula Xavier Gums Mendes

    2010-09-01

    Full Text Available A prática assistencial aqui relatada teve como objetivo desenvolver com os adolescentes participantes oficinas de prevenção ao uso de drogas. Trata-se de uma prática assistencial que parte do conhecimento, da análise da realidade dos adolescentes, do desenvolvimento de estratégias e da síntese do conhecimento construído. As oficinas foram realizadas no período de dezembro de 2003 a fevereiro de 2004, com a participação de 10 adolescentes residentes na periferia de Florianópolis e considerados em situação de vulnerabilidade e risco social. Percebeu-se que eles, dentro do seu contexto social, vivem uma incongruência com a sua vida e infringem regras sociais, impossibilitando sua realização pessoal.La práctica de atención que se describe aquí tiene por objetivo desarrollar con los adolescentes que participaron de los talleres para prevenir el consumo de drogas. Se trata de una asistencia práctica a los conocimientos, el análisis de la realidad de los adolescentes, el desarrollo de estrategias y la síntesis de los conocimientos construidos. Los talleres se llevaron a cabo entre diciembre de 2003 y febrero de 2004 con la participación de 10 adolescentes que viven en los suburbios de Florianópolis y son considerados en situación de vulnerabilidad y riesgo social. Se percibió que en sus contextos sociales tenía un desajuste con sus vidas y ellos rompían las normas sociales, lo que imposibilitaba su realización personal.The practice care reported here aimed to develop the adolescents participating workshops to prevent the use of drugs. This is a practical assistance to the knowledge, analysis of the reality of adolescents, the development of strategies and the synthesis of knowledge built. The workshops were conducted from December 2003 to February 2004 with the participation of 10 adolescents living in the suburbs of Florianopolis and considered in a situation of vulnerability and social risk. They were perceived in its

  18. Procedural sedation analgesia

    Directory of Open Access Journals (Sweden)

    Sheta Saad

    2010-01-01

    Full Text Available The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA. The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.

  19. Estudo comparativo entre bupivacaína racêmica a 0,25% e bupivacaína com excesso enantiomérico de 50% (S75-R25 a 0,25%, associadas ao fentanil para analgesia de parto com deambulação da parturiente Estudio comparativo entre bupivacaína racémica a 0,25% y bupivacaína con exceso enantiomérico de 50% (S75-R25 a 0,25% asociadas con fentanil para analgesia de parto con deambulación de la gestante Racemic 0.25% bupivacaine and 50% enantiomeric excess (S75-R25 0.25% bupivacaine associated to fentanyl for labor analgesia with patient’s ambulation. Comparative study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Figueiredo Côrtes

    2006-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos clínicos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função de menor cardiotoxicidade. A deambulação da parturiente durante o trabalho de parto pode abreviar o trabalho de parto. Este estudo visou comparar a qualidade da anestesia e as repercussões maternas e fetais bem como a capacidade de deambulação e micção espontânea das parturientes com o emprego da bupivacaína a 0,25% e da bupivacaína com excesso enantiomérico de 50% (S75-R25 a 0,25%, associadas ao fentanil por via peridural contínua, no trabalho de parto. MÉTODO: Foram avaliadas 40 parturientes, estado físico ASA I e II, feto único, em trabalho de parto, submetidas a analgesia peridural contínua e divididas em dois grupos: no grupo I, receberam 8 mL (20 mg de bupivacaína (S75-R25 a 0,25% com epinefrina, associados a 100 µg de fentanil. No grupo II, receberam 8 mL (20 mg de bupivacaína racêmica a 0,25% com epinefrina, associados a 100 µg de fentanil. Foram avaliados os seguintes parâmetros: tempo de latência, nível de bloqueio sensitivo, grau de bloqueio motor, teste de Romberg, capacidade de deambulação e micção espontânea, duração do trabalho de parto e do período expulsivo, alterações hemodinâmicas e respiratórias maternas além da vitalidade dos recém-nascidos. RESULTADOS: Não houve diferença estatística significativa entre os grupos nos parâmetros avaliados. Todas as parturientes apresentaram força muscular com capacidade de deambulação, salvo no caso de indicação de cesariana (um caso do grupo II ou quando o parto aconteceu antes do tempo previsto para avaliação deste parâmetro (quatro casos do grupo I e cinco casos do grupo II. CONCLUSÕES: Tanto a bupivacaína racêmica quanto a bupivacaína (S75-R25 a 0,25% associadas ao fentanil mostraram ser boa opção para analgesia de parto.JUSTIFICATIVA Y OBJETIVOS: Estudios clínicos con enantiómeros lev

  20. Organización y actividades preventivas en el sector del transporte de mercancías por carretera

    Directory of Open Access Journals (Sweden)

    Elena Ordaz Castillo

    2008-09-01

    Full Text Available Objetivos: Identificar los recursos y actividades preventivas más prevalentes en el sector del transporte de mercancías por carretera y los hechos diferenciales con el resto de la población trabajadora española. Metodología: Estudio descriptivo de los datos de la Encuesta de Salud y Condiciones de Trabajo del sector del transporte y estudio comparativo con el resto de la población trabajadora a través de la V-Encuesta Nacional de Condiciones de Trabajo. Para el análisis estadístico se ha aplicado el ji cuadrado y la t-student. Resultados: El 77% de las empresas de este sector tienen menos de 50 trabajadores. El 41% de los conductores señala que en su empresa no existe Delegado de Prevención y un 25% no dispone de ningún Recurso Preventivo. Destaca el alto desconocimiento existente entre los conductores de los recursos preventivos en su empresa (34,3%. La modalidad preventiva más frecuentemente instaurada en el sector es la asunción de la prevención por parte del empresario (13,6% a diferencia del resto de sectores donde predomina el SP. Ajeno (43%. Conclusiones: Predominio de la pequeña empresa en el Sector del transporte asociado a un escaso desarrollo del tejido preventivo en comparación con la población de referencia. Ambas características pueden ser determinantes de la menor actividad preventiva, más baja que la observada en la población de referencia. El acceso a actividades preventivas entre los conductores se relaciona con una mejor salud percibida.Goals: To identify the most prevalent resources and preventive activities in professional long-haul drivers and their peculiarities related to the other Spanish production branches. Methodology: We develop a descriptive analysis of data from the Survey of Health and Working Conditions in professional truck drivers and we compare these results with the other Spanish production branches through the VNational Survey on Working Conditions. The statistical analysis applied T

  1. Labour analgesia: Recent advances

    Science.gov (United States)

    Pandya, Sunil T

    2010-01-01

    Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety. PMID:21189877

  2. Epidural analgesia during labor vs no analgesia: A comparative study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  3. Epidural Analgesia in the Postoperative Period

    National Research Council Canada - National Science Library

    Mathsen, Curtis

    2001-01-01

    .... This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period...

  4. ESTRATEGIA PREVENTIVA EN SALUD MENTAL PARA DOCENTES CON ESTRÉS LABORAL

    OpenAIRE

    Barba Téllez, María Nela; Guerrero Ayala, Mayra; Ruiz Lomas, Dayana Michael

    2015-01-01

    La presente investigación tuvo como objeto de estudio la prevención de la Salud mental, donde se presenta como problema a investigar: cómo reducir el estrés laboral en los docentes. La investigación realizada permitió profundizar desde la teoría en los antecedentes y fundamentos del estrés laboral, lo que facilitó la elaboración de una propuesta de intervención en Salud mental dirigida a reducir el estrés laboral en los docentes. Para el estudio del estado real del problema antes y después de...

  5. Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia pós-operatória em colecistectomias videolaparoscópicas Administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia postoperatoria en colecistectomías videolaparoscópicas Intraperitoneal administration of 50% enantiomeric excess (S75-R25 bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia

    2007-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O efeito analgésico de infusões intraperitoneais de anestésicos locais após colecistectomia videolaparoscópica é controverso e os resultados descritos vão de alívio considerável à pequena redução da dor. O objetivo deste estudo foi avaliar a eficácia da administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para o alívio da dor no pós-operatório de colecistectomia videolaparoscópica. MÉTODO: Estudo aleatório, placebo-controlado e duplamente encoberto com 40 pacientes submetidos à colecistectomia videolaparoscópica divididos em dois grupos: GI (n = 20 que recebeu 80 mL de solução de bupivacaína S75-R25 a 0,125% intraperitoneal no fim da operação; GII (n = 20 que recebeu 80 mL de solução fisiológica a 0,9%. Ambos os grupos receberam 40 mg de tenoxicam e 30 mg.kg-1 de dipirona, por via venosa, pouco antes do fim da operação. A analgesia no pós-operatório (PO foi feita com tramadol. Foram avaliados os escores de dor em repouso, ao sentar e à manobra de Valsalva, segundo a escala numérica ao despertar e 2, 4, 8, 12 e 24 horas no PO; a presença de dor no ombro; o tempo para a primeira solicitação do analgésico; e o seu consumo cumulativo. RESULTADOS: Houve diferença estatística significativa entre os escores de dor às 12 horas no PO com o paciente em repouso (GI JUSTIFICATIVA Y OBJETIVOS: El efecto analgésico de infusiones intraperitoneales de anestésicos locales después colecistectomía videolaparoscópica es controvertido y los resultados descritos van desde el alivio considerable a la pequeña reducción del dolor. El objetivo de este estudio fue evaluar la eficacia de la administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para el alivio del dolor en el postoperatorio de colecistectomía videolaparoscópica. MÉTODO: Estudio aleatorio, placebo-controlado y doblemente encubierto con

  6. Restauración de arte contemporáneo y conservación preventiva. Un caso práctico: La Fundación Antonio Pérez de Cuenca

    OpenAIRE

    Díaz Martínez, Marta María

    2016-01-01

    El primer bloque de la tesis hace un repaso por los criterios que se tienen en cuenta a la hora de restaurar una obra de arte contemporáneo y las técnicas más empleadas. El segundo aborda el tema de la conservación preventiva y los factores a considerar en la conservación de cualquier colección. Y el tercer bloque consiste en una aplicación práctica de los anteriores, con el diseño de un plan de conservación preventiva de la Fundación Antonio Pérez, de Cuenca y los proyectos de restaura...

  7. Inmoralidad de la prisión preventiva

    OpenAIRE

    Jorge W. Álvarez

    2014-01-01

    El título no me pertenece; por eso lo pongo entre comillas, corno corresponde en rigor gramatical. Lo torné prestado de un precioso trabajo del maestro pisano Francesco Carrara, recién aparecido en una revista de criminología y que manos dilectas pusieron en las mías, conociendo mi vieja pasión por el tema. Y me dije, esto tiene que conocerse por todos los medios posibles para que la voz del viejo maestro resuene con potencia renovada.He aquí, estimado lector, el propósito de esta glosa que h...

  8. Efecto de medidas preventivas contra la toxoplasmosis en embarazadas

    OpenAIRE

    María Mercedes Santacruz; Reinaldo Heredia; Augusto Corredor Arjona

    1992-01-01

    La incidencia de la infección por Toxoplasma gondii, fue estudiada en el laboratorio de Parasitología del Instituto Nacional de Salud en los sueros de 1000 mujeres embarazadas, seleccionadas entre las que asistieron al control prenatal en la Caja de Previsión, durante los años de 1987 a 1990. En los sueros se midieron anticuerpos específicos IgG contra el Toxoplasma gondii, por la técnica de Inmunofluorescencia Indirecta. El 59% de las mujeres fueron positivas con títulos entre 1:16 y 1:4.096...

  9. Medidas preventivas de seguridad e higiene en el trabajo

    Directory of Open Access Journals (Sweden)

    Adrian Vázquez Garza

    2013-05-01

    Full Text Available En la actualidad, las nuevas tecnologías y la creciente demanda de productos en un mundo globalizado hacen que las empresas exijan más a sus empleados. En esta situación laboral se toma importancia a los riesgos de trabajo. Estos, debido a que toda acción conlleva un riesgo, por lo cual es de suma importancia contar con un departamento que prevea, analice, realice pruebas y cree normas de seguridad e higiene en el área laboral. Los autores concluyen que la creación de un departamento de seguridad es indispensable para garantizar la seguridad de los trabajadores.

  10. Trabajos en espacios confinados. Riesgos y medidas preventivas

    OpenAIRE

    Fernández, Sergio

    2012-01-01

    La ejecución de trabajos en espacios confinados resulta una necesidad en diversos sectores como por ejemplo en la industria química, redes de alcantarillado, construcción de barcos, en pozos,… con el fin desarrollar diversas tareas como limpiezas, inspecciones interiores, trabajos de pintura, reparaciones varias,… lo que implica la implantación de medidas especiales y rigurosas a planificar y llevar a cabo. Los riesgos que presentan la ejecución de estos trabajos en espacios confinados ...

  11. Low-dose spinal anaesthesia provides effective labour analgesia ...

    African Journals Online (AJOL)

    Intrathecal analgesia did not severely limit ambulation in any of the patients. ... access to epidural analgesia during labour is limited in low- resource ... world.5,6 With limited resources for epidural analgesia, spinal analgesia ... women.19,20.

  12. Reabilitação funcional e analgesia com uso de toxina botulínica A na síndrome dolorosa regional complexa tipo I do membro superior: relato de casos Rehabilitación funcional y analgesia con uso de toxina botulínica A en el síndrome doloroso regional compleja tipo I del miembro superior: relato de casos Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2005-04-01

    acometido. Se relatan dos casos de SDRC donde la aplicación de toxina botulínica-A como fármaco coadyuvante contribuyó en la recuperación funcional motora del miembro acometido. RELATO DE LOS CASOS: Dos pacientes portadoras de SDRC tipo I fueron inicialmente evaluadas para control del dolor en miembro superior derecho. Ambas presentaban incapacidad para abrir la mano y dolor por la escala analógica numérica (EAN de 10 en reposo o cuando la mano o los dedos eran pasivamente manejados. Se inició secuencia de 5 bloqueos, del ganglio estrellado ipsilateral a intervalos semanales, con clonidina y lidocaína. Simultáneamente, durante la realización del tercer bloqueo del ganglio estrellado, fue administrado 75 UI de toxina botulínica A en los músculos flexores de las falanges y de la articulación del puño. Una semana después de aplicación de la toxina botulínica A, las pacientes presentaban relajamiento de las falanges y del puño, relataban facilidad para la ejecución de la fisioterapia pasiva y el dolor clasificado fue como 2 (EAN a la manipulación pasiva. Al término de la realización de la secuencia de bloqueos del ganglio estrellado, las pacientes fueron sometidas a 3 sesiones semanales de administración por vía venosa regional de clonidina, lidocaína y parecoxib. Después de 8 meses de evaluación las pacientes presentaron 70% y 80% de recuperación motora y funcional del miembro acometido. CONCLUSIONES: La aplicación por vía muscular de toxina botulínica A resultó en mejora del movimiento del miembro acometido, analgesia auxiliando en su recuperación funcional.BACKGROUND AND OBJECTIVES: Functional inability of the affected limb is often added to alodynia and hyperalgesia in Complex Regional Pain Syndrome (CRPS type I. Two CRPS cases are reported in which botulinum toxin A as coadjuvant drug has contributed to motor and functional recovery of the affected limb. CASE REPORTS: Two CRPS type I patients were initially evaluated for upper limb pain

  13. Necesidades de accesibilidad para acciones preventivas. Una perspectiva de la población en Monterrey, México en 2005

    Directory of Open Access Journals (Sweden)

    María Eugenia Garza Elizondo

    2008-01-01

    Resultados: El 98,9% de la población estudiada recibió alguna acción preventiva. Los municipios con mayor necesidad de accesibilidad fueron Santa Catarina (Z -6,9, Apodaca (Z -1,5 y Benito Juárez (Z -1,2. San Pedro Garza García se vio más afectado por barreras de acceso geográfico o económico (Z -3.5; Apodaca, por percepción de calidad (Z -4,7; y Santa Catarina, por disponibilidad de recursos físicos, humanos o materiales (Z -4,9. Conclusiones: La mayor necesidad de accesibilidad se presentó en tres de los ocho municipios de la zona estudiada.

  14. Intervenciones preventivas de la violencia interna en el trabajo: políticas de buenas prácticas y gestión de conflictos

    Directory of Open Access Journals (Sweden)

    Antonia Bernat Jiménez

    Full Text Available La violencia interna en el lugar de trabajo es la que tiene lugar entre los trabajadores, incluidos mandos y directivos. Incluye la violencia física, el acoso sexual y el acoso psicológico, abarcando también otras conductas de violencia psicológica diferenciadas de éste. Debe ser considerada como un riesgo psicosocial, que supone un peligro importante para la salud y seguridad de las personas, y tiene repercusiones organizacionales a través de costes directos e indirectos. Considerar la violencia interna con este enfoque de riesgo laboral, supone que su abordaje se ha de realizar aplicando los principios de la acción preventiva, a la vez que permite adoptar estrategias de actuación dirigidas a la prevención del fenómeno. Las principales organizaciones a nivel mundial y nacional proponen la implementación de una política de prevención de la violencia en el lugar de trabajo. Este artículo trata sobre la conveniencia del desarrollo e implementación en las organizaciones de una política de prevención de la violencia interna, de carácter integral e integrado, que involucre a toda la organización, orientada a lograr entornos de trabajo más saludables y con un enfoque centrado en los factores organizativos y psicosociales. En el artículo se contemplan las premisas esenciales de esa política preventiva de la violencia interna, abordándose también los momentos básicos de la estrategia preventiva: - La evaluación de riesgo psicosociales. - La política de buenas prácticas. - Los procedimientos de gestión de conflictos y acoso psicológico en el trabajo. - Las estrategias de comunicación organizacional y las acciones formativas. Para conseguir auténtica efectividad, las políticas de prevención de la violencia interna deben incorporarse al Sistema de Gestión de la Prevención de la organización, que, a su vez, estará integrado en todos los sistemas de gestión restantes de la empresa.

  15. Odontología preventiva en el paciente geriátrico

    OpenAIRE

    Velasco-Ortega, Eugenio; Machuca-Portillo, Guillermo; Martínez-Sahuquillo Márquez, Ángel; Ríos-Santos, J.V.; Bullon, Pedro

    1995-01-01

    El incremento de la población mayor de 65 años y sus necesidades crecientes de tratamiento oral, está modificando el desarrollo de una filosofía preventiva odontológica para los pacientes de edad avanzada. Si queremos que los ancianos gocen de un buen estado de salud oral en la senectud, deben beneficiarse de los medios preventivos orales, actualmente a nuestro alcance. Debe prevenirse el edentulismo mediante un tratamiento integral y restaurador de las enfermedades dentales más frecuentes (c...

  16. Medidas preventivas, correctoras y compensatorias del impacto ecológico de carreteras

    OpenAIRE

    Aizpurúa Giráldez, Nerea

    2011-01-01

    Las medidas preventivas, correctoras y compensatorias empleadas en los proyectos de carretera son uno de los elementos clave para conseguir la integración ambiental de estas infraestructuras. De ellas dependerá que los posibles impactos ambientales generados durante su construcción y explotación no supongan un detrimento inadmisible de la calidad ambiental. La tipología de medidas que se vienen aplicando desde hace más de veinte años en durante el proceso de Evaluación de Impacto Ambiental (E...

  17. Obesidad Infantil. Una revisión de las intervenciones preventivas en escuelas

    OpenAIRE

    Rausch Herscovici, Cecile; Kovalskys, Irina

    2015-01-01

    Resumen Objetivo Evaluar la eficacia que tienen los componentes de las intervenciones preventivas en escuelas para mejorar la calidad nutricional, aumentar la actividad física (AF) y, ulteriormente, reducir la obesidad de los niños y adolescentes. Método Revisión de publicaciones realizadas entre los años 2009 y 2014 comprendidas en cualquiera de las siguientes categorías: revisión sistemática, metaanálisis o informes acerca del impacto de las recomendaciones y políticas gubernamentales esp...

  18. Placebo analgesia: understanding the mechanisms

    OpenAIRE

    Medoff, Zev M; Colloca, Luana

    2015-01-01

    Expectations of pain relief drive placebo analgesia. Understanding how expectations of improvement trigger distinct biological systems to shape therapeutic analgesic outcomes has been the focus of recent pharmacologic and neuroimaging studies in the field of pain. Recent findings indicate that placebo effects can imitate the actions of real painkillers and promote the endogenous release of opioids and nonopioids in humans. Social support and observational learning also contribute to placebo a...

  19. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

  20. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial

    NARCIS (Netherlands)

    Logtenberg, Slm; Oude Rengerink, K; Verhoeven, C J; Freeman, L M; van den Akker, Esa; Godfried, M B; van Beek, E; Borchert, Owhm; Schuitemaker, N; van Woerkens, Ecsm; Hostijn, I; Middeldorp, J M; van der Post, J A; Mol, B W

    OBJECTIVE: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. DESIGN: Randomised controlled equivalence trial. SETTING: Eighteen midwifery practices and six hospitals in the

  1. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  2. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

  3. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  4. Sucrose ingestion causes opioid analgesia

    Directory of Open Access Journals (Sweden)

    F.N. Segato

    1997-08-01

    Full Text Available The intake of saccharin solutions for relatively long periods of time causes analgesia in rats, as measured in the hot-plate test, an experimental procedure involving supraspinal components. In order to investigate the effects of sweet substance intake on pain modulation using a different model, male albino Wistar rats weighing 180-200 g received either tap water or sucrose solutions (250 g/l for 1 day or 14 days as their only source of liquid. Each rat consumed an average of 15.6 g sucrose/day. Their tail withdrawal latencies in the tail-flick test (probably a spinal reflex were measured immediately before and after this treatment. An analgesia index was calculated from the withdrawal latencies before and after treatment. The indexes (mean ± SEM, N = 12 for the groups receiving tap water for 1 day or 14 days, and sucrose solution for 1 day or 14 days were 0.09 ± 0.04, 0.10 ± 0.05, 0.15 ± 0.08 and 0.49 ± 0.07, respectively. One-way ANOVA indicated a significant difference (F(3,47 = 9.521, P<0.001 and the Tukey multiple comparison test (P<0.05 showed that the analgesia index of the 14-day sucrose-treated animals differed from all other groups. Naloxone-treated rats (N = 7 receiving sucrose exhibited an analgesia index of 0.20 ± 0.10 while rats receiving only sucrose (N = 7 had an index of 0.68 ± 0.11 (t = 0.254, 10 degrees of freedom, P<0.03. This result indicates that the analgesic effect of sucrose depends on the time during which the solution is consumed and extends the analgesic effects of sweet substance intake, such as saccharin, to a model other than the hot-plate test, with similar results. Endogenous opioids may be involved in the central regulation of the sweet substance-produced analgesia.

  5. Álcool e direção: uma abordagem preventiva entre clientes de bares

    Directory of Open Access Journals (Sweden)

    Bernardo Pires Sampaio

    2018-04-01

    Full Text Available Objetivo: Identificar em clientes de bares atitudes de risco e conscientizá-los dos perigos desses comportamentos via abordagem preventiva. Método: Trabalho prospectivo de caráter descritivo realizado com 119 clientes de bares entrevistados randomicamente em maio de 2016, em Ilhéus, Bahia. Usou-se questionário semiestruturado acerca das variáveis: sexo, etnia, idade, grau de escolaridade, hábito de usar cinto de segurança, consumo de álcool no momento da entrevista, responsabilidade pela condução veicular no período da realização da entrevista, hábito de dirigir alcoolizado, histórico de acidente de trânsito sob efeito de bebidas alcoólicas e local de residência. Durante a realização do questionário foi promovida uma abordagem preventiva sobre os riscos de dirigir alcoolizado e sem cinto de segurança. Resultados: Predominaram indivíduos do sexo masculinos (54%, caucasianos (41%, com idade média de 27 anos, cuja faixa etária entre 25 a 34 anos compôs mais da metade da amostra (53%, e cursando ensino superior (48%. Grande parte dos entrevistados usava cinto de segurança enquanto motoristas (77% ou como passageiros (73%. Prevaleceram entrevistados que estavam fazendo consumo de bebidas alcoólicas (74%, com predomínio daqueles que não iriam conduzir veículos após a saída do estabelecimento (58%. Preponderaram motoristas que têm hábito de dirigir sob influência de álcool (65%, dentre os quais parcela importante já se envolveu em acidente de trânsito em decorrência de tal prática (18%. A maioria dos entrevistados residia em Ilhéus (72%. Conclusão: Dirigir alcoolizado ainda é uma prática corriqueira. Contudo, os entrevistados se mostraram receptivos a intervenções preventivas acerca de acidentes de trânsito.

  6. Ketamina en analgesia multimodal postcesarea

    OpenAIRE

    Monzón Rubio, Eva María

    2011-01-01

    Mediante la analgesia multimodal influimos en las diferentes vías del dolor a la vez que minimizamos los potenciales efectos adversos de los diferentes fármacos administrados. En el caso del dolor postcesárea esto adquiere un importante matiz debido a la necesidad de disminuir el uso de opioides que pasan a la leche materna en caso de lactancia natural. El uso de dosis subanestésicas de Ketamina ha demostrado en diferentes estudios la disminución de requerimientos de opioides en las primer...

  7. Labor epidural analgesia: Past, present and future

    Directory of Open Access Journals (Sweden)

    Reena

    2014-01-01

    Full Text Available One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

  8. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

    Directory of Open Access Journals (Sweden)

    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

  9. EVALUACIÓN DE RIESGOS Y PLANIFICACIÓN PREVENTIVA DE UN PUNTO LIMPIO

    OpenAIRE

    Saavedra-Ferro, Alicia

    2013-01-01

    La actividad empresarial escogida para la realización del trabajo es una organización dedicada a la gestión de residuos, concretamente se realizará la Evaluación Inicial de Riesgos Laborales y la Planificación de la actividad preventiva de un Punto Limpio que es gestionado por dicha empresa. La justificación de la elección de esta actividad empresarial se debe a la realización del módulo de prácticas externas en el seno de una empresa de estas características y por interés pers...

  10. Fundamentos de la detención preventiva en el procedimiento penal colombiano

    Directory of Open Access Journals (Sweden)

    Leonardo Cruz Bolívar

    2012-12-01

    Full Text Available La contribución se ocupa de analizar en concreto los principios que rigen la privación preventiva de la libertad en el procedimiento penal, desde el punto de vista constitucional, legal y de instrumentos internacionales, buscando armonizar los criterios que utilizan los jueces de garantías al momento de resolver la solicitud del fiscal en esta materia. El principio de proporcionalidad constitucional, los elementos desarrollados legalmente y los pronunciamientos del sistema interamericano de derechos humanos dan base a las interpretaciones que se proponen en el artículo, buscando proteger la libertad, sin renunciar a las necesidades básicas de la justicia y la sociedad que requieren un proceso penal eficiente y que responda a la realidad nacional.

  11. PRÁCTICAS PREVENTIVAS DE LOS HABITANTES MAYORES DE 25 AÑOS EN MONTERREY Y SU ZONA METROPOLITANA (MÉXICO

    Directory of Open Access Journals (Sweden)

    Ma. Eugenia Garza

    2004-01-01

    Full Text Available Fundamento: Los padecimientos crónicos y degenerativos son las primeras causas de morbi-mortalidad en México, por lo que el Sector Salud ha implementado acciones de prevención y detección oportuna. El uso de los servicios de salud es una conducta dinámica de la población. Para que la gente utilice estas acciones de prevención es necesario que se reduzcan barreras de acceso. Así, el objetivo del estudio fue determinar la utilización de los servicios de detección de diabetes mellitus, hipertensión arterial, cáncer cérvicouterino y mamario y aplicación del toxoide tetánico diftérico. Métodos: El tamaño de la muestra fue de 254 personas de 25 años y más, que habitaban en Monterrey y su zona metropolitana. En el uso de acciones preventivas se consideró a las personas que las habían usado el año anterior. El análisis consistió en estadística descriptiva y análisis bivariado. Resultados: Más del 60% de la población correspondió al sexo femenino, la edad promedio fue de 42,3 años±14 años y tres cuartas partes de la población contó con seguridad social. Un 37% mencionó haberse realizado la detección de diabetes y un 44,5% de hipertensión, mientras que le aplicaron el toxoide tetánico diftérico a un 31,1%. En las detecciones propias de la mujer, a un 34,3% de la población femenina le practicaron la correspondiente a cáncer cérvicouterino en tanto que a un 29,5%, la de cáncer mamario. No hubo relación entre uso de acciones con antecedentes familiares y percepción de importancia de la detección. Conclusiones: El uso de las acciones preventivas está por debajo de algunos estándares internacionales. Es necesaria la búsqueda de personas expuestas al riesgo para detectar oportunamente cualquier padecimiento crónico.

  12. PREVENCIÓN DEL CONSUMO DE SUSTANCIAS PSICOACTIVAS. REVISIÓN TEÓRICA DE LOS MODELOS Y ESTRATEGIAS PREVENTIVAS

    Directory of Open Access Journals (Sweden)

    Laura Llano Sierra

    2016-01-01

    Full Text Available Se entienden los modelos conceptuales en prevención como construcciones que se han venido desarrollando lentamente, los cuales responden a contextos en los que se reflexiona acerca de la construcción teórica y la acción práctica. Dichos constructos, se van adaptando a la situación cultural, política, económica del país, teniendo en cuenta la posible relación entre los modelos preventivos y las necesidades. Lo ideal sería implementar, en cualquier acción que involucre lo teórico y lo práctico, referentes investigativos que retomen diversas perspectivas para asumir el fenómeno del consumo de sustancias psicoactivas (SPA y, por tanto, de la prevención del mismo, teniendo presente a la sustancia, al individuo y al contexto y tomando al ser humano y al consumo de SPA como un proceso dinámico compuesto por variables: psicológicas, sociales-culturales-políticas y biológicas que requieren intervención. Lo anterior se puede lograr revisando modelos teóricos que centren su atención en cada una de las variables mencionadas, para construir un modelo integrativo que dé respuesta a la globalidad de la problemática, y del que sea posible evaluar constantemente la vigencia, posibilidades de aplicación, pertinencia y relevancia. A partir del abordaje de modelos teóricos basados en las representaciones sociales, se trata la prevención referida al conjunto de creencias de un sistema cultural como tal y se menciona la necesidad de intervenir en las percepciones -estructura del pensamiento de un sujeto social inscrito en un periodo histórico y en una situación específica-, percibiendo el consumo desde otra perspectiva. Cabe mencionar que el objetivo del presente artículo es realizar una revisión teórica sobre los modelos y estrategias preventivas del consumo de sustancias psicoactivas, con el fin de orientar hipótesis partiendo de la implementación de programas de prevención.

  13. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  14. Elaboración de una herramienta para la vigilancia de indicadores de calidad de la docencia en la formación especializada de Medicina Preventiva y Salud Pública

    Directory of Open Access Journals (Sweden)

    Christian Carlo Gil-Borrelli

    2015-09-01

    Full Text Available En este trabajo se describe el proceso de creación de una herramienta para evaluar la satisfacción con la calidad de la docencia recibida en las rotaciones de la especialidad de Medicina Preventiva y Salud Pública. Para ello se adaptó la Encuesta de Satisfacción de la Formación Especializada por parte de un panel de expertos formado por 23 residentes de nueve comunidades autónomas, que valoraron y adaptaron la encuesta a las rotaciones de la especialidad mediante una escala de Likert de 5 puntos y la inclusión de nuevas dimensiones e ítems. Las dimensiones mejor valoradas fueron la planificación y la consecución de objetivos específicos, la supervisión, la delegación de responsabilidades, los recursos y el ambiente laboral del dispositivo, la valoración personal, el estímulo, el apoyo recibido y la productividad de la rotación. El desarrollo y la utilización de esta herramienta permitirán la elección informada del itinerario formativo de los residentes de Medicina Preventiva y Salud Pública.

  15. Pediatric procedural sedation and analgesia

    Directory of Open Access Journals (Sweden)

    Meredith James

    2008-01-01

    Full Text Available Procedural sedation and analgesia (PSA is an evolving field in pediatric emergency medicine. As new drugs breach the boundaries of anesthesia in the Pediatric Emergency Department, parents, patients, and physicians are finding new and more satisfactory methods of sedation. Short acting, rapid onset agents with little or no lingering effects and improved safety profiles are replacing archaic regimens. This article discusses the warning signs and areas of a patient′s medical history that are particularly pertinent to procedural sedation and the drugs used. The necessary equipment is detailed to provide the groundwork for implementing safe sedation in children. It is important for practitioners to familiarize themselves with a select few of the PSA drugs, rather than the entire list of sedatives. Those agents most relevant to PSA in the pediatric emergency department are presented.

  16. Intervención Familiar Preventiva en Programas Colaboradores del SENAME: La Perspectiva del Profesional Preventive Family Intervention in Collaborating Programs of SENAME: The Worker's Perspective

    Directory of Open Access Journals (Sweden)

    Esteban Gómez

    2008-11-01

    Full Text Available Se aborda la caracterización del usuario y concepción de la intervención, desde la perspectiva de psicólogos y trabajadores sociales de 6 Programas de Intervención Familiar colaboradores del Servicio Nacional de Menores. Se reconstruyeron sus teorías subjetivas mediante un diseño cualitativo basado en la Grounded Theory, con 12 entrevistas semi-estructuradas y 11 episódicas. Los hallazgos revelan familias con múltiples problemas y niños con sus derechos vulnerados, viviendo en contextos de pobreza y exclusión social. La intervención se concibe como un proceso preventivo integral de orientación, apoyo, empoderamiento y reparación familiar. Se concluye analizando el desafío de visualizar integradamente problemas y fortalezas en los usuarios y las limitaciones de una estrategia preventiva desarrollada en un contexto social de serias dificultades y daños.Client's characterization and conception of intervention, from the perspective of psychologists and social workers of 6 family support programs of Child Protection Services of Chile, are analyzed. Subjective theories were reconstructed by means of a qualitative design based on Grounded Theory, with 12 semi-structured and 11 episodic interviews. Findings revealed families with multiple problems and children whose rights had been violated, living in environments of poverty and social exclusion. The intervention is conceived as an integral preventive process of orientation, support, empowerment, and family repair. In the conclusion, the challenge of considering with equal importance clients' problems and strengths is analyzed, showing the limitations of a preventive strategy developed in a social context of serious difficulties and damages.

  17. Mulheres com idade igual ou superior a 50 anos: ações preventivas da infecção pelo HIV Mujeres com edad igual o superior a 50 años: acciones preventivas de la infección por el VIH The 50-year-old women or older: preventive actions to the HIV infection

    Directory of Open Access Journals (Sweden)

    Daniela Angelo de Lima Rodrigues

    2010-06-01

    Full Text Available Trata-se de pesquisa qualitativa que buscou verificar a adoção de ações preventivas da transmissão do HIV por mulheres com idade igual ou superior a 50 anos, moradoras em uma comunidade de baixa renda e atendidas pelo Programa Saúde da Família, no Município de São Paulo. Adotou-se como referencial teórico a Antropologia Médica e, para o tratamento dos dados, o Discurso do Sujeito Coletivo. Foram entrevistadas 13 mulheres e são apresentados três discursos: valorizando a prevenção; invisibilidade do HIV/aids; e rejeição à adesão ao preservativo. A análise mostrou que o grupo não se percebia em risco à infecção pela via sexual devido à confiança na fidelidade do parceiro. O eventual uso do preservativo foi atribuído somente à curiosidade. As ações preventivas adotadas carecem de embasamento científico. Os resultados alertam para a necessidade do planejamento e da implementação de intervenções culturalmente embasadas direcionadas ao segmento estudado.Se trata de una investigación cualitativa que buscó verificar la adopción de acciones preventivas de la transmisión del VIH por mujeres con edad igual o superior a 50 años, moradoras en una comunidad de baja renta y atendidas por el Programa Salud de la Familia, en el municipio de São Paulo, Brasil. Se adoptó como referencial teórico la Antropología Médica y, para el tratamiento de los datos, el Discurso del Sujeto Colectivo. Se entrevistaron 13 mujeres y son presentados tres discursos: valorar la prevención; invisibilidad del VIH/SIDA; rechazo a la adherencia al preservativo. El análisis apuntó que el grupo no percibió el riesgo a la infección por la vía sexual a causa de la confianza en la fidelidad del compañero. El eventual uso del preservativo fue atribuido solamente a la curiosidad. Las acciones preventivas adoptadas carecen de base científica. Los resultados alertan para la necesidad del planeamiento y de la implantación de intervenciones

  18. Intranasal sufentanil/ketamine analgesia in children

    DEFF Research Database (Denmark)

    Nielsen, Bettina Nygaard; Friis, Susanne M; Rømsing, Janne

    2014-01-01

    The management of procedural pain in children ranges from physical restraint to pharmacological interventions. Pediatric formulations that permit accurate dosing, are accepted by children and a have a rapid onset of analgesia are lacking....

  19. Post-caesarean analgesia: What is new?

    Directory of Open Access Journals (Sweden)

    Sukhyanti Kerai

    2017-01-01

    Full Text Available Adequate post-operative analgesia after caesarean section (CS is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy.

  20. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    OpenAIRE

    Stolik-Dollberg, Orit C; Dollberg, Shaul

    2005-01-01

    Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB) when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivac...

  1. Conservación preventiva para objetos arqueológicos históricos en contextos urbanos

    OpenAIRE

    Frazzi, Patricia

    2002-01-01

    This article pretends to demonstrate that preventive conservation of archaeo­logical objects from historical periods is possible, at rather low costs, if in the precise moment, the right decisions are taken. This article pretends to demonstrate that preventive conservation of archaeo­logical objects from historical periods is possible, at rather low costs, if in the precise moment, the right decisions are taken. Este trabalho pretende demonstrar que a conservação preventiva de objetos a...

  2. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  3. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Liv M

    2012-07-01

    Full Text Available Abstract Background Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. Methods/design The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia. Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief. Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity, mode of delivery and maternal and neonatal side effects. The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. Discussion This study, considering cost

  4. Epidural analgesia, neonatal care and breastfeeding.

    Science.gov (United States)

    Zuppa, Antonio Alberto; Alighieri, Giovanni; Riccardi, Riccardo; Cavani, Maria; Iafisco, Alma; Cota, Francesco; Romagnoli, Costantino

    2014-11-29

    The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.

  5. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    Directory of Open Access Journals (Sweden)

    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  6. Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial

    NARCIS (Netherlands)

    Douma, M.R.; Stienstra, R.; Middeldorp, J.M.; Arbous, M.S.; Dahan, A

    2015-01-01

    BACKGROUND: Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity. METHODS: Parturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or

  7. Prevención de abusos sexuales a menores en Internet: Acciones preventivas online (en España).

    OpenAIRE

    Pulido Rodríguez, Cristina

    2010-01-01

    El estudio científico de la prevención online de abusos sexuales a menores es reciente. En el caso de nuestro país, es prácticamente inexistente, por ello se ha realizado esta tesis doctoral. La contribución principal de la tesis es la identificación de las recomendaciones científicas y sociales necesarias a incorporar en la acción preventiva online de nuestro país. La estructura de la tesis doctoral es la siguiente: Describe en un primer apartado el estado de la cuestión que incluye la descr...

  8. Policia Preventiva en la Región Central de México y el Modelo Gaditano de Seguridad Interior

    OpenAIRE

    Yañez, Arturo

    2003-01-01

    El argumento central de Arturo Yáñez es que "la policía preventiva no es, jurídicamente, una fuerza pública" debido a que constitucionalmente, funciones de seguridad interior son adjudicadas a la Guardia Nacional (5). Yáñez sostiene que una de las principales causas de esta ambigüedad es la influencia del modelo de seguridad interior previsto en la Constitución de Cadiz (1812) sobre la Constitución Federal mexicana. La confusión conceptual en torno a la función judicial ha provocado que la po...

  9. Epidural anesthesia and postoperatory analgesia with alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy in bitches

    Science.gov (United States)

    Pohl, Virgínia H.; Carregaro, Adriano B.; Lopes, Carlize; Gehrcke, Martielo I.; Muller, Daniel C.M.; Garlet, Clarissa D.

    2012-01-01

    The aim of this study was to determine the viability and cardiorespiratory effects of the association of epidural alpha-2 adrenergic agonists and lidocaine for ovariohysterectomy (OH) in bitches. Forty-two bitches were spayed under epidural anesthesia with 2.5 mg/kg body weight (BW) of 1% lidocaine with adrenaline (CON) or in association with 0.25 mg/kg BW of xylazine (XYL), 10 μg/kg BW of romifidine (ROM), 30 μg/kg BW of detomidine (DET), 2 μg/kg BW of dexmedetomidine (DEX), or 5 μg/kg BW of clonidine (CLO). Heart rate (HR), respiratory rate (fR) and arterial pressures were monitored immediately before and every 10 min after the epidural procedure. Blood gas and pH analysis were done before, and at 30 and 60 min after the epidural procedure. Animals were submitted to isoflurane anesthesia if they presented a slightest sign of discomfort during the procedure. Time of sensory epidural block and postoperative analgesia were evaluated. All animals in CON and DEX, 5 animals in ROM and CLO, 4 animals in XYL, and 3 in DET required supplementary isoflurane. All groups, except CLO, showed a decrease in HR. There was an increase in arterial pressures in all groups. Postoperative analgesia lasted the longest in XYL. None of the protocols were totally efficient to perform the complete procedure of OH; however, xylazine provided longer postoperative analgesia than the others. PMID:23277701

  10. Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia.

    Science.gov (United States)

    Sutton, Caitlin D; Butwick, Alexander J; Riley, Edward T; Carvalho, Brendan

    2017-08-01

    We examined the characteristics of women who choose nitrous oxide for labor analgesia and identified factors that predict conversion from nitrous oxide to labor neuraxial analgesia. Retrospective descriptive study. Labor and Delivery Ward. 146 pregnant women who used nitrous oxide for analgesia during labor and delivery between September 2014 and September 2015. Chart review only. Demographic, obstetric, and intrapartum characteristics of women using nitrous oxide were examined. Multivariable logistic regression was performed to identify factors associated with conversion from nitrous oxide to neuraxial analgesia. Data are presented as n (%), median [IQR], adjusted relative risk (aRR), and 95% confidence intervals (CI) as appropriate. During the study period, 146 women used nitrous oxide for labor analgesia (accounting for 3% of the total deliveries). The majority (71.9%) of women who used nitrous oxide were nulliparous, and over half (51.9%) had expressed an initial preference for "nonmedical birth." The conversion rate to neuraxial blockade was 63.2%, compared to a concurrent institutional rate of 85.1% in women who did not use nitrous oxide. Factors associated with conversion from nitrous oxide to neuraxial blockade were labor induction (aRR=2.0, CI 1.2-3.3) and labor augmentation (aRR=1.7, CI 1.0-2.9). Only a small number of women opted to use nitrous oxide during labor, analgesia was minimal, and most converted to neuraxial analgesia. Women with induced and augmented labors should be counseled about the increased likelihood that they will convert to neuraxial analgesia. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  12. Electroacupuncture analgesia in a rabbit ovariohysterectomy.

    Science.gov (United States)

    Parmen, Valentin

    2014-02-01

    This study investigated the effectiveness of electroacupuncture analgesia (EAA) at local and paravertebral acupoints for a rabbit undergoing an ovariohysterectomy. Twelve clinically healthy New Zealand white rabbits were chosen and divided into two groups: the control group (5 rabbits) and the experimental group (7 rabbits). A neuroleptanalgesic (ketamine + xylazine) was administered to the control group (NLA group); the experimental group received EAA treatment (EAA group). The EAA treatment includes one acupuncture formula for local stimulation at the incision site and systemic stimulation. Results of clinical research have shown postoperative analgesia using EAA treatment to be superior to that using NLA. The average postoperative recovery time was 5.2 times longer in the NLA group than in the EAA group. Because consciousness was maintained, EAA presented an advantage in thermoregulation. Animals administered NLA had prolonged thermal homeostasis because of neurovegetative disconnection. For the EAA group, the operative times were characterized as excellent (28%, p = 0.28) or good (72%, p = 0.72). Local stimulation at the incision site provided excellent analgesia of the abdominal wall (100%). In conclusion, EA can provide general analgesia with a considerable analgesic effect for a rabbit undergoing an ovariohysterectomy, resulting in a short postoperative recovery time. Copyright © 2014. Published by Elsevier B.V.

  13. Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2004-06-01

    . Todavia, não se pode dispensar rigorosa vigilância a fim de se obter analgesia satisfatória e diminuir as complicações.JUSTIFICATIVA Y OBJETIVOS: La analgesia promovida por la infusión peridural de anestésico local con analgésicos opioides es reconocidamente de buena calidad y con pocos efectos adversos. El objetivo de este estudio fue determinar el número, formas y gravedad de las complicaciones pós-operatorias relacionadas a la analgesia peridural y a la inserción del catéter peridural. MÉTODO: Fueron evaluados, retrospectivamente, 469 pacientes sometidos a la analgesia peridural pós-operatoria entre 18/10/1999 y 18/10/2001. La analgesia peridural fue conducida usándose solución de bupivacaína 0,1% con fentanil (1 a 5 µg.ml-1, iniciándose la infusión a 3 ml.h-1. La velocidad de infusión era ajustada de acuerdo con la queja álgica del paciente. Fueron analizadas las siguientes variables: la duración de la infusión peridural; la ocurrencia de efectos adversos y complicaciones, relacionándolos a los datos demográficos, tipo de cirugía y posición del catéter peridural; y la calidad de la analgesia obtenida con la técnica (escala analógico-visual de dolor e índice de satisfacción del paciente. RESULTADOS: Los catéteres peridurales permanecieron implantados por una media de 2,2 días, variando de 6 horas a 10 días, y el índice global de complicaciones relacionadas a la técnica fue de 46,3%, siendo que la mayoría fue de pequeña magnitud, sin repercusión clínica. De estas, 13,9% estaban relacionadas directamente al catéter peridural (desconección, exteriorización, dolor lumbar, inflamación e infección local. Otras complicaciones más comunes fueron encontradas: vómitos y retención urinaria. La analgesia pós-operatoria fue efectiva con 97,2% de los pacientes refiriendo satisfacción con la técnica. Pacientes sin dolor o con dolor leve, en el primero, segundo y tercero días de pós-operatorio, constituyeron, respectivamente, 80

  14. Patient controlled remifentanil and epidural analgesia during labour : satisfaction, costs and safety

    NARCIS (Netherlands)

    Freeman, Liv

    2016-01-01

    Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women randomised to remifentanil PCA. Costs of epidural analgesia and remifentanil PCA are not significantly

  15. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed......: feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than...... inferior alveolar nerve injury. All grades of loss of neurosensory and gustatory functions were found, and a range of persisting neurogenic malfunctions was reported. Subjective complaints and neurosensory function tests indicate that lingual nerve lesions are more incapacitating than inferior alveolar...

  16. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). ......Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994......;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly...

  17. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

  18. MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTY

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    I. G. Mukutsa

    2012-01-01

    Full Text Available Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale, a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05. The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05 and the second verticalization (70%, 25% and 17%, p ≤ 0.05. Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

  19. Prehospital Use of Ketamine in Battlefield Analgesia

    Science.gov (United States)

    2012-03-08

    Breathing a. In a casualty with progressive respiratory distress and known or suspected torso trauma , consider a tension pneumothorax and... pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch needle/catheter unit inserted in the second...Military Advanced Regional Anesthesia and Analgesia Handbook, U.S. Special Operations Command Tactical Trauma Protocols (since 2008), Army Ranger Medic

  20. Considerações sobre analgesia controlada pelo paciente em hospital universitário Consideraciones sobre analgesia controlada por el paciente en hospital universitario Patient controlled analgesia in a university hospital

    Directory of Open Access Journals (Sweden)

    Guilherme Antônio Moreira de Barros

    2003-02-01

    qualidade da analgesia, embora com ocorrência de efeitos colaterais indesejáveis, tendo havido boa aceitação da técnica de analgesia pelas clínicas atendidas.RESUMEN JUSTIFICATIVA Y OBJETIVOS: El rápido progreso obtenido en las técnicas quirúrgicas y anestésicas en los últimos años proporcionó extraordinario aumento de las indicaciones de procedimientos invasivos. Por otro lado, con el envejecimiento de la población, el período de recuperación pós-operatoria pasó a ser motivo de mayor preocupación y consecuente preocupación del equipo de salud. Para tanto, nuevas técnicas de analgesia fueron creadas y desarrolladas y, entre ellas, se destaca la Analgesia Controlada por el Paciente (ACP. En nuestro país, el Servicio de Dolor Agudo (SEDA de la Disciplina de Terapia Antálgica y Cuidados Paliativos, del Departamento de Anestesiología de la Facultad de Medicina de Botucatu - UNESP, utiliza hace muchos años esta técnica de analgesia. Con la finalidad de atestar la calidad del servicio prestado, la pesquisa objetiva verificar la eficacia y seguridad del método, así como identificar y caracterizar la población atendida. MÉTODO: De modo retrospectivo, fueron evaluados 679 pacientes tratados por el SEDA, exclusivamente con el método de ACP, durante tres años. Los pacientes fueron incluidos en el análisis aleatoriamente, sin restricciones cuanto a la edad, al sexo, al tipo de cirugía y considerando únicamente la posibilidad de indicación de la ACP. Fueron estudiados los siguientes atributos: sexo, edad, tipo de cirugía, intensidad del dolor, días de acompañamiento, analgésicos utilizados, vías de administración, ocurrencia de efectos colaterales y complicaciones de la técnica. RESULTADOS 3,96% de los pacientes sometidos a cirugías, y 1,64% de los internados en el período observado, fueron acompañados con técnica ACP. La cirugía torácica fue la más frecuentemente atendida, con 25% de los pacientes. La morfina fue el medicamento m

  1. Respondiendo a una pandemia emergente: Zika y los métodos anticonceptivos como medida preventiva

    Directory of Open Access Journals (Sweden)

    Akram Hernández-Vásquez

    2017-01-01

    Full Text Available El virus del Zika ha ido expandiéndose rápidamente en América Latina y el Caribe. El Perú aún no reporta casos autóctonos, ambientales con los países afectados pueden establecer las condiciones adecuadas para la infección del Aedes aegypti, vector del virus del Zika y su posterior transmisión a los humanos, desencadenando una epidemia como la que sucedió con el virus del dengue en años anteriores. Además de la enfermedad febril aguda que el virus produce, la posible asociación con el incremento de casos de síndrome de Guillain-Barré en adultos, el aumento en la incidencia de microcefalia en recién nacidos, así como el reporte de la transmisión por vía sexual, han generado gran preocupación tanto en la población como en los decisores de la salud pública, a tal grado que la Organización Mundial de la Salud (OMS ha decretado alerta mundial…

  2. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  3. Combined spinal epidural labour analgesia: Complications and their management

    OpenAIRE

    YILMAZ, Nurullah; KOCAMANOGLU, Ismail Serhat; ABANOZ, Hakan

    2016-01-01

    Combined spinal-epidural analgesia (CSEA) is an effective and increasingly popular analgesia method used in vaginal delivery. CSEA provides rapid and excellent analgesia, allows mobilization, reduces drug consumption significantly and generally causes negligible maternal and fetal /neonatal adverse effects /complications not requiring treatment. The resulting adverse effects /complications are often associated with technical and /or agent/agents used and cause maternal and fetal /neonatal or,...

  4. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    OpenAIRE

    Varaprasad

    2015-01-01

    BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of seda...

  5. Selective REM Sleep Deprivation Improves Expectation-Related Placebo Analgesia.

    Science.gov (United States)

    Chouchou, Florian; Chauny, Jean-Marc; Rainville, Pierre; Lavigne, Gilles J

    2015-01-01

    The placebo effect is a neurobiological and psychophysiological process known to influence perceived pain relief. Optimization of placebo analgesia may contribute to the clinical efficacy and effectiveness of medication for acute and chronic pain management. We know that the placebo effect operates through two main mechanisms, expectations and learning, which is also influenced by sleep. Moreover, a recent study suggested that rapid eye movement (REM) sleep is associated with modulation of expectation-mediated placebo analgesia. We examined placebo analgesia following pharmacological REM sleep deprivation and we tested the hypothesis that relief expectations and placebo analgesia would be improved by experimental REM sleep deprivation in healthy volunteers. Following an adaptive night in a sleep laboratory, 26 healthy volunteers underwent classical experimental placebo analgesic conditioning in the evening combined with pharmacological REM sleep deprivation (clonidine: 13 volunteers or inert control pill: 13 volunteers). Medication was administered in a double-blind manner at bedtime, and placebo analgesia was tested in the morning. Results revealed that 1) placebo analgesia improved with REM sleep deprivation; 2) pain relief expectations did not differ between REM sleep deprivation and control groups; and 3) REM sleep moderated the relationship between pain relief expectations and placebo analgesia. These results support the putative role of REM sleep in modulating placebo analgesia. The mechanisms involved in these improvements in placebo analgesia and pain relief following selective REM sleep deprivation should be further investigated.

  6. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W. M.; Franssen, Maureen T. M.; Papatsonis, Dimitri N. M.; Hajenius, Petra J.; van Huizen, Marloes E.; Bremer, Henk A.; van den Akker, Eline S. A.; Woiski, Mallory D.; Porath, Martina M.; van Beek, Erik; Schuitemaker, Nico; van der Salm, Paulien C. M.; Fong, Bianca F.; Radder, Celine; Bax, Caroline J.; Sikkema, Marko; van den Akker-van Marle, M. Elske; van Lith, Jan M. M.; Lopriore, Enrico; Uildriks, Renske J.; Struys, Michel M. R. F.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2012-01-01

    Background: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a

  7. Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial.

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Huizen, M.E. van; Bremer, H.A.; Akker, E.S. van den; Woiski, M.D.; Porath, M.M.; Beek, E. van; Schuitemaker, N.; Salm, P.C. van der; Fong, B.F.; Radder, C.; Bax, C.J.; Sikkema, M.; Akker-van Marle, M.E. van den; Lith, J.M. van; Lopriore, E.; Uildriks, R.J.; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2012-01-01

    ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries,

  8. Labor analgesia: An update on the effect of epidural analgesia on labor outcome

    Directory of Open Access Journals (Sweden)

    Samina Ismail

    2013-01-01

    Full Text Available Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS. There is no ideal study on the effect of epidural analgesia (EA on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

  9. Intervenciones preventivas de la violencia interna en el trabajo: políticas de buenas prácticas y gestión de conflictos Internal violence at work preventive interventions: good practice policies and conflict management

    Directory of Open Access Journals (Sweden)

    Antonia Bernat Jiménez

    2011-01-01

    Full Text Available La violencia interna en el lugar de trabajo es la que tiene lugar entre los trabajadores, incluidos mandos y directivos. Incluye la violencia física, el acoso sexual y el acoso psicológico, abarcando también otras conductas de violencia psicológica diferenciadas de éste. Debe ser considerada como un riesgo psicosocial, que supone un peligro importante para la salud y seguridad de las personas, y tiene repercusiones organizacionales a través de costes directos e indirectos. Considerar la violencia interna con este enfoque de riesgo laboral, supone que su abordaje se ha de realizar aplicando los principios de la acción preventiva, a la vez que permite adoptar estrategias de actuación dirigidas a la prevención del fenómeno. Las principales organizaciones a nivel mundial y nacional proponen la implementación de una política de prevención de la violencia en el lugar de trabajo. Este artículo trata sobre la conveniencia del desarrollo e implementación en las organizaciones de una política de prevención de la violencia interna, de carácter integral e integrado, que involucre a toda la organización, orientada a lograr entornos de trabajo más saludables y con un enfoque centrado en los factores organizativos y psicosociales. En el artículo se contemplan las premisas esenciales de esa política preventiva de la violencia interna, abordándose también los momentos básicos de la estrategia preventiva: - La evaluación de riesgo psicosociales. - La política de buenas prácticas. - Los procedimientos de gestión de conflictos y acoso psicológico en el trabajo. - Las estrategias de comunicación organizacional y las acciones formativas. Para conseguir auténtica efectividad, las políticas de prevención de la violencia interna deben incorporarse al Sistema de Gestión de la Prevención de la organización, que, a su vez, estará integrado en todos los sistemas de gestión restantes de la empresa.Internal violence in the workplace is

  10. ENDOGENOUS ANALGESIA, DEPENDENCE, AND LATENT PAIN SENSITIZATION

    Science.gov (United States)

    Taylor, Bradley K; Corder, Gregory

    2015-01-01

    Endogenous activation of μ-opioid receptors (MORs) provides relief from acute pain. Recent studies have established that tissue inflammation produces latent pain sensitization (LS) that is masked by spinal MOR signaling for months, even after complete recovery from injury and re-establishment of normal pain thresholds. Disruption with MOR inverse agonists reinstates pain and precipitates cellular, somatic and aversive signs of physical withdrawal; this phenomenon requires N-methyl-D-aspartate receptor-mediated activation of calcium-sensitive adenylyl cyclase type 1 (AC1). In this review, we present a new conceptual model of the transition from acute to chronic pain, based on the delicate balance between LS and endogenous analgesia that develops after painful tissue injury. First, injury activates pain pathways. Second, the spinal cord establishes MOR constitutive activity (MORCA) as it attempts to control pain. Third, over time, the body becomes dependent on MORCA, which paradoxically sensitizes pain pathways. Stress or injury escalates opposing inhibitory and excitatory influences on nociceptive processing as a pathological consequence of increased endogenous opioid tone. Pain begets MORCA begets pain vulnerability in a vicious cycle. The final result is a silent insidious state characterized by the escalation of two opposing excitatory and inhibitory influences on pain transmission: LS mediated by AC1 (which maintains accelerator), and pain inhibition mediated by MORCA (which maintains the brake). This raises the prospect that opposing homeostatic interactions between MORCA analgesia and latent NMDAR–AC1-mediated pain sensitization create a lasting vulnerability to develop chronic pain. Thus, chronic pain syndromes may result from a failure in constitutive signaling of spinal MORs and a loss of endogenous analgesic control. An overarching long-term therapeutic goal of future research is to alleviate chronic pain by either: a) facilitating endogenous opioid

  11. Comunicar con los visitantes: una nueva faceta profesional para los conservadores-restauradores

    OpenAIRE

    Mateos Rusillo, Santos M. (Santos Miguel)

    2012-01-01

    Los recursos patrimoniales están más expuestos que nunca a la interacción con los visitantes. Por tanto, ya no basta con trasladar a un público mayoritario unos determinados contenidos culturales, pues la actual situación demanda la inclusión de un tipo de mensajes que fomenten y favorezcan la relación recurso-visitante de forma sostenible. Y es precisamente la Difusión preventiva, entendida como una estrategia de sensibilización para informar y persuadir a los visitantes de la extrema fragil...

  12. Proyectar con la naturaleza mediante la Metodología de los Estudios de Impacto Ambiental en ordenaciones residenciales

    OpenAIRE

    Higueras García, Esther

    2013-01-01

    Proyectar con la naturaleza mediante la Metodología de los Estudios de Impacto Ambiental en ordenaciones residenciales .- Procedimiento de acción en la planificación ambiental .- Las técnicas de agregación de impactos .- Las afecciones de los planes de ordenación sobre el territorio. .- Las medidas preventivas y correctoras de planes .- Evaluación critica de los estudios de impacto ambiental

  13. Neonatal respiratory depression associated with epidural analgesia

    Directory of Open Access Journals (Sweden)

    Alberto Gálvez Toro

    2013-06-01

    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  14. Epidural Labor Analgesia and Maternal Fever.

    Science.gov (United States)

    Sharpe, Emily E; Arendt, Katherine W

    2017-06-01

    Women receiving an epidural for labor analgesia are at increased risk for intrapartum fever. This relationship has been supported by observational, before and after, and randomized controlled trials. The etiology is not well understood but is likely a result of noninfectious inflammation as studies have found women with fever have higher levels of inflammatory markers. Maternal pyrexia may change obstetric management and women are more likely to receive antibiotics or undergo cesarean delivery. Maternal pyrexia is associated with adverse neonatal outcomes. With these consequences, understanding and preventing maternal fever is imperative.

  15. Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.

    Science.gov (United States)

    Schenk, Michael R; Putzier, Michael; Kügler, Bjoern; Tohtz, Stephan; Voigt, Kristina; Schink, Tania; Kox, Wolfgang J; Spies, Claudia; Volk, Thomas

    2006-11-01

    Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery. Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P turn in bed was achieved earlier in the PCEA group (P Patients in the PCEA group were significantly more satisfied with pain therapy (P patient satisfaction when compared with PCIA after spinal fusion surgery.

  16. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...

  17. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    Science.gov (United States)

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  18. Is placebo analgesia mediated by endogenous opioids? A systematic review

    NARCIS (Netherlands)

    ter Riet, G.; de Craen, A. J.; de Boer, Anthonius; Kessels, A. G.

    1998-01-01

    This systematic review assesses six experimental studies into the mechanism of placebo analgesia in human subjects suffering from clinical pain or experimentally induced ischaemic arm pain. Due to their sophisticated designs, these studies probably provide the best evidence that placebo analgesia

  19. Acupuncture Mechanisms: Anesthesia, Analgesia and Protection on Organ Functions

    Directory of Open Access Journals (Sweden)

    Jing Wang

    2015-01-01

    Full Text Available Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles, lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.

  20. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  1. Antenatal education for childbirth-epidural analgesia.

    Science.gov (United States)

    Cutajar, Lisa; Cyna, Allan M

    2018-05-07

    The language structures used by antenatal educators have not been previously researched in the context of antenatal childbirth classes. Epidural analgesia for labour is a common, and a frequently asked about, component of antenatal education for parents in hospitals providing maternity care. We aimed to identify the way information is described and presented by childbirth educators to assess content and determine which language structures such as metaphor, suggestion, information and storytelling are utilized. This observational study of antenatal education was conducted at a single tertiary referral center for maternity care in Western Sydney, Australia. All three childbirth educators agreed to be video recorded whilst providing information to parents during antenatal classes. Audio data was subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. For the purposes of the current study, data concerning a single topic was used for the analysis-'epidural analgesia for labour'. Language structures used were highly variable between educators, as was the content and time taken for the information being provided. Our findings represent a first attempt to identify baseline information used in the clinical setting of antenatal education in order to categories communication structures used. This study has identified areas for further improvements and consistency in the way educators provide information to parents and has important implications for future midwifery practice, education and research. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Gráfica urbana como comunicación visual preventiva

    Directory of Open Access Journals (Sweden)

    D.G. Natalia Vanesa Morales Suvires

    2010-11-01

    Full Text Available Este trabajo se plantea desde el enfoque del Diseño Gráfico con el fin de contribuir de manera significativa al incremento de la concientización respecto de la amenaza sísmica existente en la provincia de San Juan. Metodológicamente el proyecto se desglosó en tres etapas: 1 relevamiento de la gráfica comunicacional existente; 2 análisis y evaluación; y 3 formulación de pautas de prevención y mitigación de los efectos del riesgo sísmico. De este modo se han definido pautas de comunicación visual que responden a los aspectos de identidad cultural de la zona, las necesidades puntuales de la población, los recursos locales, y la posible aceptación de la comunidad, todo dentro del marco de la prevención sísmica.

  3. Registered nurses' and midwives' knowledge of epidural analgesia.

    Science.gov (United States)

    Bird, Annette; Wallis, Marianne; Chaboyer, Wendy

    2009-01-01

    Despite epidural analgesia increasingly being utilized in hospitals, very little research-based evidence is available about registered nurses' (RNs) and midwives' knowledge of this technique. To describe the current epidural knowledge levels of RNs and midwives in a multi-site setting. RNs and midwives at four, regional teaching facilities completed an epidural knowledge test. The instrument included demographic items and five knowledge subscales relating to epidural analgesia: spinal cord anatomy and physiology; epidural pharmacology; complications of epidural analgesia; assessment of sensory and motor blockade and the general management of patients with epidural analgesia. A total of 408 (99.7% response) RNs and midwives completed the test. Respondents demonstrated good knowledge of sensory and motor blockade assessment and the general management of epidural analgesia subscales with correct responses to 75 and 77% of the questions in these subscales, respectively. Fair knowledge relating to the spinal cord anatomy and physiology subscale was demonstrated with 69% of the questions answered correctly. The knowledge subscales relating to epidural pharmacology (57% correct responses) and the complications of epidural analgesia (56% correct responses) were problematic for the sample. The research results provide generalizable information about what RNs and midwives know about epidural analgesia. These results are an important guide in the development of new and existing dedicated epidural education programs. The results also provide some direction for further research into this important topic.

  4. Labour analgesia and the baby: good news is no news.

    Science.gov (United States)

    Reynolds, Felicity

    2011-01-01

    When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. It depresses fetal muscular activity, aortic blood flow, short-term heart rate variability and oxygen saturation. In the newborn it exacerbates acidosis, depresses Apgar scores, respiration, neurobehavioural score, muscle tone and suckling. Alternatives have few advantages, remifentanil being the most promising. Neuraxial analgesia is associated with better Apgar scores and variable neurobehavioural changes. Neonatal acid-base status is not only better with epidural than with systemic opioid analgesia, it is also better than with no analgesia. The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated. Copyright © 2010 Elsevier Ltd. All rights reserved.

  5. Consumo de frutas y verduras en escolares como estrategia preventiva del sobrepeso y obesidad infantiles

    Directory of Open Access Journals (Sweden)

    Mario Delgado-Noguera

    2013-10-01

    Full Text Available Title: Fruit and vegetables in school as a preventive strategy of overweight and obesity in children.ResumenEl problema del sobrepeso y la obesidad, subvalorados en el pasado, representan en la actualidad una preocupante epidemia en Salud Pública en el mundo elevando el riesgo de padecer Enfermedades Crónicas No Transmisibles (ECNT y produciendo discapacidades físicas y problemas psicológicos. Los niños y adolescentes no escapan del problema principalmente porque están inmersos en ambientes obesogénicos donde se exponen a una creciente oferta de alimentos procesados industrialmente de alto contenido calórico como las bebidas endulzadas, y por el aumento del sedentarismo. Tampoco están ingiriendo una adecuada cantidad de frutas y verduras ya que se reconoce que su consumo de 400 g al día puede prevenir la obesidad y las ECNT. Desde 2009 Colombia cuenta con un marco legal para enfrentar el problema del sobrepeso y obesidad infantiles y el bajo consumo de FV. Se conoce además que las escuelas son ambientes propicios para intervenciones potencialmente efectivas que aumenten el consumo de estos nutrientes porque ofrecen el acceso a grandes poblaciones de estudiantes y dan la oportunidad de institucionalizar programas de promoción de alimentación saludable. Se recomienda crear estrategias locales para que las escuelas sean incluidas en un plan preventivo de las ECNT. (DUAZARY 2012 No. 2, 151 - 158AbstractThe problem of overweight and obesity, undervalued in the past, now represent a public health epidemic in the world because the overweight and obesity raising the risk of Chronic Noncommunicable Diseases (NCD, physical disability and psychological problems. Children and adolescents had been immersed in obesogenic environments. Simultaneously they are exposed to a growing supply of industrially processed foods, high in calories and a sedentary lifestyle. The children and adolescents not are eating adequate amounts of fruits and vegetables

  6. Safety and efficacy of prolonged epidural analgesia after oncologic colorectal surgery

    Directory of Open Access Journals (Sweden)

    R. V. Garyaev

    2012-01-01

    Full Text Available This study demonstrates effective thoracic epidural analgesia by ropivacain 0.2 %, phentanyl 2 mkg/ml, adrenaline 2 mkg/ml in single-use infusion pumps in 124 patients, who underwent surgery for colorectal cancer. Safe, effective and controllable analgesia was observed during surgery and postoperative period. Prolonged analgesia facilitates early rehabilitation and improves gastrointestinal peristaltic activity.  Prolonged epidural analgesia is the recommended method of analgesia in this group of patients.

  7. Analgesia after total hip replacement: epidural versus psoas ...

    African Journals Online (AJOL)

    tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

  8. Expectant fathers' experience during labor with or without epidural analgesia.

    Science.gov (United States)

    Capogna, G; Camorcia, M; Stirparo, S

    2007-04-01

    For men the worst aspect of childbirth is witnessing their partner in pain. The aim of this study was to investigate fathers' attitudes towards labor and delivery with and without epidural analgesia. The study was performed using a questionnaire that included yes/no, multiple choice or 6-point ordinal scale answers. Expectant fathers whose partners were nullipara between 36 and 38 weeks of gestation were recruited and the questionnaires were administered on the day after the birth. To investigate paternal anxiety during labor, the State part of the State-Trait Anxiety Inventory was used. The questionnaire was completed by 243 fathers. Sixty percent (145) of the parturients received epidural analgesia and 40% (98) did not. Paternal characteristics were comparable. Fathers whose partners did not receive epidural analgesia felt their presence as troublesome and unnecessary (Pinvolvement (Pfathers whose partners did not or did receive epidural analgesia (Pinvolvement, participation and satisfaction with the experience of childbirth.

  9. Analgesia and anaesthesia in childbirth: obscurantism and obfuscation.

    Science.gov (United States)

    Mander, R

    1998-07-01

    The terms 'analgesia' and 'anaesthesia' have been defined by emphasizing differing aspects of their effects. The distinction between these interventions has not been clarified by their definitions. The historical remedies for pain were similarly unclear. This lack of clarity is apparent in the introduction of chloroform in childbirth, which has much in common with the introduction and effects of epidural analgesia. The reasons for and benefits of this lack of clarity are examined.

  10. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    ão necessários para avaliar diferença na incidência de cesarianas.JUSTIFICATIVA Y OBJETIVOS: El alivio del dolor en el trabajo de parto ha recibido una atención constante objetivando el bienestar materno, disminuyendo el estrés causado por el dolor y reduciendo las consecuencias de éste sobre el concepto. Innumerables técnicas pueden ser utilizadas para la analgesia de parto. Este trabajo tuvo como objetivo comparar la técnica peridural continua con la combinada, ambas con el uso de bupivacaína a 0,25% en exceso enantiomérico 50% y fentanil como agentes. MÉTODO: Participaron del estudio 40 parturientes en trabajo de parto con dilatación cervical entre 4 y 5 cm que se repartieron en de los grupos iguales de forma aleatoria. El Grupo I recibió anestesia peridural continua. El Grupo II recibió anestesia combinada. Se evaluaron: medidas antropométricas, edad de embarazo, dilatación cervical, tiempo entre el bloqueo y la ausencia de dolor a través de la escala analógica visual, posibilidad de deambulación, tiempo entre el inicio de la analgesia y la dilatación cervical completa, duración del período expulsivo, parámetros hemodinámicos maternos y vital edad del recién nacido. Posibles complicaciones como depresión respiratoria, hipotensión arterial materna, prurito, náuseas y vómitos también fueron observados. Para la comparación de los promedios se utilizó el teste t de Student y para la paridad y tipo de parto se utilizó el teste del Qui-cuadrado. RESULTADOS: No hubo diferencia estadística significativa entre los de los grupos con relación al tiempo entre el inicio de la analgesia y la dilatación cervical completa, como también con relación al tiempo de la duración del período expulsivo, incidencia de cesárea relacionada con la analgesia, parámetros hemodinámicos maternos y vital edad del recién nacido. CONCLUSIONES: Las dos técnicas fueron eficaces y seguras para la analgesia del trabajo de parto, aunque la técnica combinada haya

  11. Successful practice of electroacupuncture analgesia in equine surgery.

    Science.gov (United States)

    Sheta, Eldessouky; Ragab, Safwat; Farghali, Haithem; El-Sherif, Asmaa

    2015-02-01

    Electroacupuncture analgesia was used for surgery in horses and donkeys. A KWD-808 electrical stimulator was used to incrementally induce a dense, dispersed wave output at frequencies from 20 to 55 Hz, which was maintained at a frequency of 55 Hz, and to change the amplitude of the wave to the best grading number for the suggested operation in each animal. Induction of analgesia lasted for 20-30 minutes, and the effect of analgesia was maintained for 20-45 minutes depending on the type of surgery performed. The exhibited clinical signs, physical examination data, and the responses of all animals were used for evaluating the periods of analgesia. Although the majority of the cases (95%) had no response to strong surgical pain, they experienced significant increases in heart rates and respiratory rates during induction. The lack of pain, relaxed surgical procedures, reduced intraoperative bleeding, and improved healing without complications were all definite benefits of using electroacupuncture analgesia in surgery. Thus, this study has provided surgical evidence supporting the effectiveness of electroacupuncture analgesia, as well as confirming its reliability, in the field of equine anesthesia and surgery. Copyright © 2015. Published by Elsevier B.V.

  12. [Observation on analgesia effect of electroacupuncture during gynecologic outpatient operation].

    Science.gov (United States)

    Wang, Xiao-Hui; Wu, Xue-Lei; Jin, Ping-Lin; Wang, Lu-Dong; Zhao, Zhi-En; Qin, Xue-Yu; Zhang, Zhi-Yan; Hu, Xue-Zhu; Cai, Zhen-Lin

    2012-10-01

    To verify the feasibility of electroacupuncture analgesia applied to gynecologic outpatient operation. Two hundred patients were randomly divided into an electroacupuncture analgesia group and an intravenous anesthesia group, 100 cases in each group. Operation types included artificial abortion, diagnostic curettage and remove of intrauterine divice. The electroacupuncture analgesia group was treated with electroacupuncture at bilateral Hegu (LI 4) and Neiguan (PC 6), and the routine gynecologic outpatient operation was performed under patients' waking state. The intravenous anesthesia group was treated with routine gynecologic outpatient operation after intravenous injection of fentanyl and propofol. The excellent rate and the effective rate of analgesia were 88.0% (88/100) and 100.0% (100/100) in the electroacupuncture analgesia group, and 94.0% (94/100) and 100.0% (100/100) in the intravenous anesthesia group, with no statistically significant differences between the two groups (all P > 0.05). There was no adverse reaction in the electroacupuncture anesthesia group, but 11 cases of adverse reactions in the intravenous anesthesia group. Electroacupuncture analgesia can effectively alleviate the pain during gynecologic outpatient operation and it is simple and safe without adverse reactions.

  13. HACIA LA AUTOSOSTENIBILIDAD EN PROCESOS DE EXCAVACIÓN: CONSERVACIÓN PREVENTIVA Y GESTIÓN DE RIESGOS

    Directory of Open Access Journals (Sweden)

    Ana Pastor Pérez

    2017-02-01

    A lo largo de este estudio veremos cómo estas herramientas de gestión del patri- monio juegan un papel destacado por medio de la utilización de sistemas jerárqui- cos: a nivel de gestión de espacios y de los riesgos que afectan a los mismos. En estas disciplinas el conservador-restaurador pasa a tener un rol más dinámico en la toma de decisiones, colaborando en la selección de aquellas áreas que deben reservarse  o  excavarse  (conservación  espacial  de  manera  que  se  preserven  el máximo de objetos, restos y estructuras (optimización de recursos. Los yacimien- tos arqueológicos en proceso de excavación suponen un reto que nos enfrenta a contextos en constante cambio. Esto dificulta llevar a cabo estrategias a medio y largo plazo debido a las modificaciones que se producen en torno a los hallazgos y áreas de estudio. En este paper veremos cómo la conservación preventiva en arqueología se ha impuesto a la curativa o a la restauración (definiciones según ICOM, destacando como técnica que potencia la auto-sostenibilidad ya que per- mite una anticipación a los riesgos, donde se propicie un mejor uso de los recur- sos económicos y humanos disponibles.

  14. Diseño de una arquitectura para redes de sensores con soporte para aplicaciones de detección de eventos

    OpenAIRE

    LINO RAMIREZ, CARLOS

    2012-01-01

    Las aplicaciones para redes de sensores inalámbricas, o Wireless Sensor Networks (WSNs), han mostrado un crecimiento significativo en los últimos años. Actualmente constituyen una alternativa tecnológica interesante para el desarrollo de aplicaciones que requieren monitorizar constantemente el estado de cualquier variable relacionada con escenarios de diversos ámbitos. Si las aplicaciones detectan cambios en los valores de dichas variables, pueden activar la ejecución de acciones preventivas ...

  15. Sedação e analgesia em neonatologia Sedación y analgesia en neonatología Sedation and analgesia in neonatology

    Directory of Open Access Journals (Sweden)

    Yerkes Pereira e Silva

    2007-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais. A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.JUSTIFICATIVA Y OBJETIVOS: La importancia del estudio del dolor en neonatología se debe al hecho de que la sensación de dolor y de estrés significa sufrimiento e incomodidad para los recién nacidos y, a pesar de ese conocimiento poco se ha hecho para reducirlo. Dentro de esa revisión se discutieron: la prevención del dolor, las medidas no farmacológicas ye farmacológicas para su tratamiento y la sedación en recién nacidos. CONTENIDO: Varias son las medidas no-farmacológicas que pueden ser tomadas con el objetivo de prevenir el

  16. Book review. Anestesia e analgesia locoregionale del cane e del gatto. Francesco Staffieri

    Directory of Open Access Journals (Sweden)

    Manuel Graziani

    2014-03-01

    Full Text Available Il volume di anestesia e analgesia locoregionale del cane e del gatto è pensato per essere un testo "da sala operatoria" – come afferma l'autore – perché consente un rapido, ma allo stesso tempo dettagliato, consulto per il libero professionista che si trova a gestire un'anestesia. Si tratta di un piccolo libro, tascabile, che può essere considerato un punto di partenza per gli studenti e per tutti quei medici veterinari che intendono avvicinarsi in maniera specialistica all'arte dell'anestesiologia veterinaria. L'anestesia locoregionale costituisce, infatti, uno strumento insostituibile per la gestione del dolore perioperatorio in medicina veterinaria. Nel volume si forniscono le nozioni di base per praticare i principali blocchi nervosi centrali e periferici. Per ogni blocco sono riportate le tecniche alla cieca (mediante l'ausilio dei punti di repere anatomici e quelle con l'impiego dello stimolatore nervoso periferico. Il volume, corredato da immagini foto e grafici, per un totale di 65 figure, si apre con i capitoli relativi ai farmaci, agli strumenti e alle complicanze dell'anestesia locoregionale. Prosegue con i blocchi nervosi centrali (anestesia epidurale e spinale e si conclude con i blocchi periferici (testa, arto anteriore, torace, arto posteriore. L'autore, Francesco Staffieri, è un medico veterinario che svolge il dottorato di ricerca nel Dipartimento delle Emergenze e dei Trapianti di Organi, Sezioni di Cliniche Veterinarie e Produzioni Animali dell'Università degli Studi Aldo Moro di Bari.

  17. EPIDURAL LABOUR ANALGESIA IN IZOLA GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sabina Verem

    2018-02-01

    Full Text Available Background. The study presents the experience with epidural analgesia (EPA for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 % EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005, longer labour length (278 vs 222 min; p < 0.0005, higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001 and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001. The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7, lowest during the transition stage (VAS 1.5 and some higher during the second phase (VAS 2.7. Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental

  18. Prevención de riesgos laborales y su relación con el género de los trabajadores

    Directory of Open Access Journals (Sweden)

    José Luis Llorca Rubio

    2013-09-01

    Full Text Available OBJETIVO: el objetivo de este estudio consistió en analizar si existen diferencias en la gestión preventiva llevada a cabo en varias empresas que presentaron enfermedades profesionales en función del género de los trabajadores. MÉTODOS: se analizó una muestra de 302 trabajadores, siendo el 31,1% mujeres, de empresas donde se había declarado enfermedad profesional en la provincia de Valencia (España. Los datos se recogieron mediante un cuestionario con 40 preguntas. RESULTADOS: los resultados indicaron que en estas empresas se realizaba una gestión preventiva en la que el plan de prevención y la participación de los trabajadores eran las actividades que con menor frecuencia se aplicaban, y en el caso de las mujeres la gestión preventiva llevada a cabo resultaba significativamente peor que para los hombres. CONCLUSIONES: se concluye que con referencia a la prevención de riesgos laborales el género puede ser una variable que genera una discriminación negativa hacia las mujeres trabajadoras. Además, los riesgos laborales y los problemas de salud asociados deberían ser considerados un problema de salud pública.

  19. Bloqueo de los nervios iliohipogástrico e ilioinguinal para analgesia posquirúrgica en cesárea tipo Pfannenstiel realizada bajo anestesia general: ¿qué concentración del anestésico local usar? Iliohypogastric and ilioinguinal block for postsurgical analgesia after pfannenstiel cesarean section performed under general anaesthesia

    Directory of Open Access Journals (Sweden)

    Héctor Iván García García

    1998-03-01

    Full Text Available El bloqueo bilateral de los nervios Iliohipogástrico e Ilioinguinal con bupivacaína al 0.5% puede proveer analgesia luego de cesárea con incisión de Pfannenstiel aunque la cantidad de droga usada está cerca de la dosis máxima segura. Diseñamos este estudio para comparar el efecto analgésico de la bupivacaína al 0.5% y diluida al 0.25%. Se incluyeron treinta pacientes aleatoriamente asignadas a un grupo de estudio (bupivacaína 0.25%, n= 15 y uno de control (bupivacaína 0.5%, n=15. Se evaluaron las pacientes con una Escala Visual Análoga (EVA a las O, 4, 8, 12 y 24 horas posoperatorias por médicos que no sabían a qué grupo pertenecían y sólo en caso de necesidad se prescribió analgesia IM con Diclofenaco. Los puntajes de analgesia y los requerimientos de anal. gesia complementaria fueron notoriamente simila. res en ambos grupos y no hubo diferencias estadísticamente significativas. Concluimos que el bloqueo de estos nervios es una técnica analgésica efectiva (el dolor siempre estuvo en promedio por debajo de 4 en la EVA, que no es afectada por la dilución del anestésico y que además es segura pues no se presentaron complicaciones. The Iliohypogastric and Ilioinguinal bilate. ral block with 0.5% bupivacaine can provide analgesia after Pfannenstiel cesarean section although the required amount of the drug is near the maximum secure dose. We designed this study in order to compare the analgesic effect of 0.5% bupivacaine and diluted 0.25% bupivacaine. Thirty patients were included in the study and asigned in aleatory form to either a study (0.25% bupivacaine n=15 or a control group (0.5% bupivacaine n=15. They were evaluated with the Visual Analogue Scale (VAS at 0,4,8,12,24 postoperative hours by physicians who did not know the group of the patient and prescribed intramuscular analgesia with Dicofenac only if required. The analgesia scores and the complementery analgesia requirements were similar in both groups and there were

  20. Analgesia/anesthesia for external cephalic version.

    Science.gov (United States)

    Weiniger, Carolyn F

    2013-06-01

    Professional society guidelines recommend that women with breech presentation be delivered surgically due to a higher incidence of fetal risks compared with vaginal delivery. An alternative is attempted external cephalic version, which if successful, enables attempted vaginal delivery. Attitudes towards external cephalic version (ECV) will be considered in this review, along with pain relief methods and their impact on ECV success rates. Articles suggest that ECV is infrequently offered, due to both physician and patient factors. Success of ECV is higher in multiparous women, complete breech, posterior placenta, or smaller fetus. Preterm ECV performance does not increase vaginal delivery rates. Neuraxial techniques (spinal or epidural) significantly increase ECV success rates, as do moxibustion and hypnosis. Four reviews summarized studies considering ECV and neuraxial techniques. These reviews suggest that neuraxial techniques using high (surgical) doses of local anesthetic are efficacious compared with control groups not using anesthesia, whereas techniques using low-doses are not. Low-dose versus high-dose neuraxial analgesia/anesthesia has not been directly compared in a single study. Based on currently available data, the rate of cephalic presentation is not increased using neuraxial techniques, but vaginal delivery rates are higher. ECV appears to be a low-risk procedure. The logistics of routine ECV and provision of optimal neuraxial techniques for successful ECV require additional research. Safety aspects of neuraxial anesthesia for ECV require further investigation.

  1. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  2. Analgesia, sedation, and memory of intensive care.

    Science.gov (United States)

    Capuzzo, M; Pinamonti, A; Cingolani, E; Grassi, L; Bianconi, M; Contu, P; Gritti, G; Alvisi, R

    2001-09-01

    The purpose of this article was to investigate the relationship between analgesia, sedation, and memory of intensive care. One hundred fifty-two adult, cooperative intensive care unit (ICU) patients were interviewed 6 months after hospital discharge about their memory of intensive care. The patient was considered to be cooperative when he/she was aware of self and environment at the interview. The patients were grouped as follows: A (45 patients) substantially no sedation, B (85) morphine, and C (22) morphine and other sedatives. The patients having no memory of intensive care were 38%, 34%, and 23% respectively, in the three groups. They were less ill, according to SAPS II (P memories was not different among the three groups. Females reported at least one emotional memory more frequently than males (odds ratio 4.17; 95% CI 10.97-1.59). The patients receiving sedatives in the ICU are not comparable with those receiving only opiates or nothing, due to the different clinical condition. The lack of memory of intensive care is present in one third of patients and is influenced more by length of stay in ICU than by the sedation received. Sedation does not influence the incidence of factual, sensation, and emotional memories of ICU admitted patients. Females have higher incidences of emotional memories than males. Copyright 2001 by W.B. Saunders Company

  3. Newborn Analgesia Mediated by Oxytocin during Delivery

    Science.gov (United States)

    Mazzuca, Michel; Minlebaev, Marat; Shakirzyanova, Anastasia; Tyzio, Roman; Taccola, Giuliano; Janackova, Sona; Gataullina, Svetlana; Ben-Ari, Yehezkel; Giniatullin, Rashid; Khazipov, Rustem

    2011-01-01

    The mechanisms controlling pain in newborns during delivery are poorly understood. We explored the hypothesis that oxytocin, an essential hormone for labor and a powerful neuromodulator, exerts analgesic actions on newborns during delivery. Using a thermal tail-flick assay, we report that pain sensitivity is two-fold lower in rat pups immediately after birth than 2 days later. Oxytocin receptor antagonists strongly enhanced pain sensitivity in newborn, but not in 2-day-old rats, whereas oxytocin reduced pain at both ages suggesting an endogenous analgesia by oxytocin during delivery. Similar analgesic effects of oxytocin, measured as attenuation of pain-vocalization induced by electrical whisker pad stimulation, were also observed in decerebrated newborns. Oxytocin reduced GABA-evoked calcium responses and depolarizing GABA driving force in isolated neonatal trigeminal neurons suggesting that oxytocin effects are mediated by alterations of intracellular chloride. Unlike GABA signaling, oxytocin did not affect responses mediated by P2X3 and TRPV1 receptors. In keeping with a GABAergic mechanism, reduction of intracellular chloride by the diuretic NKCC1 chloride co-transporter antagonist bumetanide mimicked the analgesic actions of oxytocin and its effects on GABA responses in nociceptive neurons. Therefore, endogenous oxytocin exerts an analgesic action in newborn pups that involves a reduction of the depolarizing action of GABA on nociceptive neurons. Therefore, the same hormone that triggers delivery also acts as a natural pain killer revealing a novel facet of the protective actions of oxytocin in the fetus at birth. PMID:21519396

  4. Psychophysical testing of spatial and temporal dimensions of endogenous analgesia: conditioned pain modulation and offset analgesia.

    Science.gov (United States)

    Honigman, Liat; Yarnitsky, David; Sprecher, Elliot; Weissman-Fogel, Irit

    2013-08-01

    The endogenous analgesia (EA) system is psychophysically evaluated using various paradigms, including conditioned pain modulation (CPM) and offset analgesia (OA) testing, respectively, the spatial and temporal filtering processes of noxious information. Though both paradigms assess the function of the EA system, it is still unknown whether they reflect the same aspects of EA and consequently whether they provide additive or equivalent data. Twenty-nine healthy volunteers (15 males) underwent 5 trials of different stimulation conditions in random order including: (1) the classic OA three-temperature stimulus train ('OA'); (2) a three-temperature stimulus train as control for the OA ('OAcon'); (3) a constant temperature stimulus ('constant'); (4) the classic parallel CPM ('CPM'); and (5) a combination of OA and CPM ('OA + CPM'). We found that in males, the pain reduction during the OA + CPM condition was greater than during the OA (P = 0.003) and CPM (P = 0.07) conditions. Furthermore, a correlation was found between OA and CPM (r = 0.62, P = 0.01) at the time of maximum OA effect. The additive effect found suggests that the two paradigms represent at least partially different aspects of EA. The moderate association between the CPM and OA magnitudes indicates, on the other hand, some commonality of their underlying mechanisms.

  5. Comunicar con los visitantes: una 'nueva' faceta profesional para los conservadores-restauradores

    Directory of Open Access Journals (Sweden)

    Santos M. Mateos Rusillo

    2013-12-01

    Full Text Available Los recursos patrimoniales están más expuestos que nunca a la interacción con los visitantes. Por tanto, ya no basta con trasladar a un público mayoritario unos determinados contenidos culturales, pues la actual situación demanda la inclusión de un tipo de mensajes que fomenten y favorezcan la relación recurso-visitante de forma sostenible. Y es precisamente la Difusión preventiva, entendida como una estrategia de sensibilización para informar y persuadir a los visitantes de la extrema fragilidad de los recursos patrimoniales, la que lo permite de forma óptima. Además, utilizar esta estrategia es una magnífica herramienta al servicio de la identidad corporativa de los propios recursos patrimoniales y de sus conservadores-restauradores. Normalmente, muchas cuestiones relacionadas con las políticas y acciones de conservación preventiva no se explicitan a los visitantes, pero al integrarse en el discurso que se les traslada, permite que estos tengan una idea cabal de esos esfuerzos, lo que redunda en la imagen que tienen del recurso en cuestión y, por extensión, de sus conservadores-restauradores.

  6. Adesão às medidas preventivas de pneumonia associada à ventilação mecânica.

    Directory of Open Access Journals (Sweden)

    Luany Caroline Adamovicz Bork

    2015-01-01

    Full Text Available Justificativa e Objetivos: Ressaltando a relevância da adoção de medidas preventivas de infecção para a realização de uma assistência livre de danos emergiu a necessidade de observar como a equipe de saúde aplica o bundle. Objetivou-se verificar a adesão de medidas preventivas de pneumonia pelos profissionais de saúde, da Unidade de Terapia Intensiva geral adulta de um hospital público, Ponta Grossa-PR. Métodos: Pesquisa transversal, de abordagem quantitativa, prospectiva e observacional, realizada no período de abril a julho de 2013. A amostra constituiu-se de 33 pacientes que estavam em ventilação mecânica, totalizando o registro de 1522 momentos de aplicações das medidas preventivas de pneumonia associada à ventilação mecânica (PAVM. Resultados: Dos 33 pacientes, 13 desenvolveram pneumonia, a média de idade foi de 59,72 anos e a prevalência foi do gênero feminino (44,44%. Verificou-se que os profissionais de saúde atenderam a cabeceira elevada dos leitos em média 69,80%, assim como aderiram à interrupção da sedação em média 66,66%, realizaram a higiene oral com clorexidina 94,61%, mantiveram o cuff do tubo orotraqueal (entre 20 e 25 mmH20 64,44%, adequaram o filtro de nebulizador para ficar dentro da validade 89,50% e em 93,4% das observações deixaram os circuitos livre de condensados. Analisou-se que o valor médio de dias passados em ventilação mecânica dos pacientes que adquiriram infecção foi de 15,85 (DP = 8,65 dias. Conclusão: Revela-se que quando a equipe aplica todas as medidas preventivas ao paciente sob ventilação mecânica há redução do risco de adquirir infecção no trato respiratório. DESCRITORES: Terapia intensiva; Pneumonia associada à ventilação mecânica; Infecção hospitalar; Equipe de assistência ao paciente.

  7. "Tem mulher, tem preventivo": sentidos das práticas preventivas do câncer do colo do útero entre mulheres de Salvador, Bahia, Brasil

    OpenAIRE

    Rico, Ana María; Iriart, Jorge Alberto Bernstein

    2013-01-01

    O objetivo deste trabalho foi compreender os significados das práticas preventivas do câncer do colo do útero entre mulheres de bairros populares de Salvador, Bahia, Brasil. Trata-se de estudo qualitativo, baseado na análise de conteúdo de entrevistas semiestruturadas com 15 mulheres entre 24 e 68 anos. Os resultados evidenciam alta valorização do Papanicolaou, que é realizado como parte de exames de rotina, sem, no entanto, sustentar-se no conhecimento biomédico sobre as suas funções. Além d...

  8. Evaluación de riesgos y planificación de acciones preventivas en fábrica de envasado de agua mineral.

    OpenAIRE

    Rodríguez Fernández, Fernando

    2013-01-01

    En el TFM se ha llevado a cabo una Evaluación de Riesgos de una fábrica de envasado de agua mineral. Se ha evaluado el puesto de trabajo "Operario de paletizado y enfardado de botellas 1'5l." para el cual obtenemos sólamente dos riesgos moderados. Departamento de Anatomía Patológica, Microbiología, Medicina Preventiva y Salud Pública, Medicina Legal y Forense Gestión de la Prevención de Riesgos Laborales, Calidad y Medio Ambiente

  9. A garantia da ordem pública como fundamento para a prisão preventiva e o desenvolvimento de seu conceito no Supremo Tribunal Federal

    OpenAIRE

    Soares, Antonio Marcos

    2013-01-01

    Resumo: Esta monografia tem como objetivo tratar de forma pormenorizada a garantia da ordem pública, circunstância legal autorizadora da decretação da prisão preventiva do imputado trazida pelo artigo 312, do Código de Processo Penal. Trata-se de instituto dotado de um conceito vago que enseja custódia provisória, a qual deveria apresentar natureza cautelar, porém, assume contornos diversos da instrumentalidade lhe exigida. No mais das vezes é adotada como medida de defesa social, assumindo a...

  10. Preemptive analgesia I: physiological pathways and pharmacological modalities.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

  11. Preemptive analgesia II: recent advances and current trends.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

  12. Parameter Optimization Analysis of Prolonged Analgesia Effect of tDCS on Neuropathic Pain Rats

    Science.gov (United States)

    Wen, Hui-Zhong; Gao, Shi-Hao; Zhao, Yan-Dong; He, Wen-Juan; Tian, Xue-Long; Ruan, Huai-Zhen

    2017-01-01

    Background: Transcranial direct current stimulation (tDCS) is widely used to treat human nerve disorders and neuropathic pain by modulating the excitability of cortex. The effectiveness of tDCS is influenced by its stimulation parameters, but there have been no systematic studies to help guide the selection of different parameters. Objective: This study aims to assess the effects of tDCS of primary motor cortex (M1) on chronic neuropathic pain in rats and to test for the optimal parameter combinations for analgesia. Methods: Using the chronic neuropathic pain models of chronic constriction injury (CCI), we measured pain thresholds before and after anodal-tDCS (A-tDCS) using different parameter conditions, including stimulation intensity, stimulation time, intervention time and electrode located (ipsilateral or contralateral M1 of the ligated paw on male/female CCI models). Results: Following the application of A-tDCS over M1, we observed that the antinociceptive effects were depended on different parameters. First, we found that repetitive A-tDCS had a longer analgesic effect than single stimulus, and both ipsilateral-tDCS (ip-tDCS) and contralateral-tDCS (con-tDCS) produce a long-lasting analgesic effect on neuropathic pain. Second, the antinociceptive effects were intensity-dependent and time-dependent, high intensities worked better than low intensities and long stimulus durations worked better than short stimulus durations. Third, timing of the intervention after injury affected the stimulation outcome, early use of tDCS was an effective method to prevent the development of pain, and more frequent intervention induced more analgesia in CCI rats, finally, similar antinociceptive effects of con- and ip-tDCS were observed in both sexes of CCI rats. Conclusion: Optimized protocols of tDCS for treating antinociceptive effects were developed. These findings should be taken into consideration when using tDCS to produce analgesic effects in clinical applications. PMID

  13. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  14. Pre-emptive analgesia: Recent trends and evidences

    Directory of Open Access Journals (Sweden)

    Amiya K Mishra

    2013-01-01

    Full Text Available Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period has the potential to be more effective than a similar analgesic treatment initiated after surgery. This article aims to review all the recent published evidences that assess the efficacy of this enigmatic concept. Materials and Methods: We reviewed original research articles, case-reports, meta-analyses, randomized control trials (RCTs, and reviews based on pain physiology for preemptive analgesia from Medline, Medscape, and PubMed from 1993 to 2013. A broad free-text search in English was undertaken with major keywords "Preemptive analgesia," "postoperative pain," "preoperative," and "preincisional". Results: Review of publications showed that intravenous (IV nonsteroidal anti-inflammatory drugs (NSAIDs are quite effective when used alone, as well as with low dose iv ketamine, preemptively to provide adequate postoperative analgesia. However, ketamine has a doubtful role as a standalone agent. Preemptive administration of LA at the incision site reduces postoperative pain, but achieves an analgesic effect similar to that of postincisional anesthetic infiltration as does intraperitoneal administration. Preemptive epidural analgesia has proved its efficacy in controlling perioperative immune function and pain in comparison to parenteral opioids. Gamma-amino butyric acid (GABA analogues like gabapentin and pregabalin have great potential as preemptive analgesic with the added advantage of its anxiolytic effect. Conclusion: Multimodal approaches that address multiple sites along the pain pathway is necessary to treat pain adequately. However, we need to find an answer to the question of how to obtain the maximal clinical benefits with the use of preemptive analgesia.

  15. Effect of pain and analgesia on compensatory reserve.

    Science.gov (United States)

    Hinojosa-Laborde, Carmen; Fernandez, Jessie Renee D; Muniz, Gary W; Nawn, Corinne D; Burns, Rebecca K; Le, Thuan H; Porter, Kathy B; Hardy, John T; Convertino, Victor A

    2017-07-01

    The measurement of the body's capacity to compensate for reduced blood volume can be assessed with a compensatory reserve measurement (CRM). The CRM, which is calculated from changes in features of the arterial waveform, represents the integration of compensatory mechanisms during states of low tissue perfusion and oxygenation, such as hemorrhage. This study was designed to test the hypothesis that pain which activates compensatory mechanisms and analgesia that result in reduced blood pressure are associated with lower compensatory reserve. This study evaluated CRM in obstetric patients during labor as pain intensity increased from no pain to severe pain and compared CRM before and after epidural anesthesia. CRM was calculated from a finger pulse oximeter placed on the patient's index finger and connected to the DataOx monitor in healthy pregnant women (n = 20) before and during the active labor phase of childbirth. As pain intensity, based on an 11-point scale (0, no pain; 10, worst pain), increased from 0 to 8.4 ± 0.9 (mean ± SD), CRM was not affected (81 ± 10% to 82 ± 13%). Before analgesia, CRM was 84 ± 10%. CRM at 10 minutes, 20 minutes, 30 minutes, 40 minutes, 50 minutes, and 60 minutes after analgesia was 82 ± 11%, 83 ± 14%, 83 ± 15%, 86 ± 12%, 89 ± 9%, and 87 ± 10%, respectively. There was a transient 2% reduction followed by a 5% increase in CRM from before to after epidural anesthesia (p = 0.048). Pain scores before and after analgesia were 7 ± 2 and 1 ± 1, respectively (p < 0.001). These results indicate that pain and analgesia contribute minimally, but independently to the reduction in compensatory reserve associated with trauma and hemorrhage. As such, our findings suggest that analgesia can be safely administered on the battlefield while maintaining the maximal capacity of mechanisms to compensate for blood loss. Diagnostic study, level II.

  16. Effect of aquapuncture on postoperative analgesia after ovariohysterectomy in dogs

    Directory of Open Access Journals (Sweden)

    Stelio Luna

    2015-07-01

    Full Text Available Aquapuncture (AqP consists of a water or saline solution injection into acupoints. This study aimed to evaluate the effect of aquapuncture on post-operative analgesia in bitches submitted to elective ovariohysterectomy (OHE. The study was prospective, randomised, and blinded for pain assessment. Sixteen dogs were randomly distributed in two groups of eight animals each. All animals were sedated with 0.05 mg kg-1 of acepromazine intramuscularly (IM, 30 minutes prior to induction of anaesthesia with propofol and maintenance with isoflurane. Eight animals underwent bilateral acupoint injection with 0.1 ml of 0.9% saline (AqP at Gall Bladder 34, Stomach 36, Liver 3 and Spleen 6 acupoints 15 minutes after sedation. Pain score was investigated after 0.5, 1, 2, 5, 8 and 24 hours post-operatively and was compared with a control untreated group of eight animals. Morphine, at 0.5 mg kg-1 IM, was administered when the numerical rating scale was above 33% of the maximum value, in order to control post-operative pain in both groups. There were no differences in cardiorespiratory variables and pain and sedation scores between the groups. Seven (87.5% animals from the control group required rescue analgesia at the first two postoperative hours and five (62.5% animals treated with AqP required rescue analgesia, however, only one (12.5% animal was treated at the first two hours and the remaining animals were treated from 5 hours after surgery. Aquapuncture produced residual analgesia up to 5 h after surgery and may be an option for post-operative analgesia in bitches undergoing OHE, providing that pain is assessed and rescue analgesia administered if necessary.

  17. Neonatal morphine enhances nociception and decreases analgesia in young rats.

    Science.gov (United States)

    Zhang, Guo Hua; Sweitzer, Sarah M

    2008-03-14

    The recognition of the impact of neonatal pain experience on subsequent sensory processing has led to the increased advocacy for the use of opioids for pain relief in infants. However, following long-term opioid exposure in intensive care units more than 48% of infants exhibited behaviors indicative of opioid abstinence syndrome, a developmentally equivalent set of behaviors to opioid withdrawal as seen in adults. Little is known about the long-term influence of repeated neonatal morphine exposure on nociception and analgesia. To investigate this, we examined mechanical and thermal nociception on postnatal days 11, 13, 15, 19, 24, 29, 39 and 48 following subcutaneous administration of morphine (3 mg/kg) once daily on postnatal days 1-9. The cumulative morphine dose-response was assessed on postnatal days 20 and 49, and stress-induced analgesia was assessed on postnatal days 29 and 49. Both basal mechanical and thermal nociception in neonatal, morphine-exposed rats were significantly lower than those in saline-exposed, handled-control rats and naive rats until P29. A rightward-shift of cumulative dose-response curves for morphine analgesia upon chronic neonatal morphine was observed both on P20 and P49. The swim stress-induced analgesia was significantly decreased in neonatal morphine-exposed rats on P29, but not on P49. These data indicate that morphine exposure equivalent to the third trimester of gestation produced prolonged pain hypersensitivity, decreased morphine antinociception, and decreased stress-induced analgesia. The present study illustrates the need to examine the long-term influence of prenatal morphine exposure on pain and analgesia in the human pediatric population.

  18. Is urinary drainage necessary during continuous epidural analgesia after colonic resection?

    DEFF Research Database (Denmark)

    Basse, L; Werner, M; Kehlet, H

    2000-01-01

    BACKGROUND AND OBJECTIVES: Postoperative urinary retention may occur in between 10% and 60% of patients after major surgery. Continuous lumbar epidural analgesia, in contrast to thoracic epidural analgesia, may inhibit urinary bladder function. Postoperative urinary drainage has been common...... that routine bladder catheterization beyond postoperative day 1 may not be necessary in patients with ongoing continuous low-dose thoracic epidural analgesia....

  19. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... and two months later. The midwives were interviewed two hours after the birth. Method of analysis: The “Idealtype-” method, the “importance-” method and the “process-” method described by Bo Eneroth. Results: Two ideal-types were discovered: the worried and the unworried mother. Important and common...

  20. Stellate ganglion blockade for analgesia following upper limb surgery.

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

  1. Promoción de la salud y prevención de las enfermedades para un envejecimiento activo y con calidad de vida

    Directory of Open Access Journals (Sweden)

    Elizabeth Aliaga-Díaz

    Full Text Available Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de muchos factores como el físico, cognoscitivo y sociofamiliar; por otro lado, tienen características como la heterogeneidad, la gran carga de enfermedad, la pluripatología, entre otras, que repercuten no solo en el ámbito familiar sino social. Es importante ofrecer a la población adulta mayor los medios para ejercer un mejor control sobre su salud y mejorarla. Todo ello con el fin de lograr un envejecimiento exitoso, es decir, sin discapacidad, con la menor cantidad de enfermedades posibles o adecuadamente controladas y, sobre todo, intentando mantener en todo momento su autonomía y calidad de vida, respetando siempre sus valores y preferencias. Por otro lado, las actividades preventivas en los adultos mayores deben tener en cuenta no solo el riesgo de enfermedad, sino también la alteración de la función que produce la enfermedad, así como aquellas condiciones frecuentes en el adulto mayor que pueden deteriorar su estado de salud como la fragilidad, las caídas, y las complicaciones iatrogénicas; las actividades preventivas en el adulto mayor deben estar dirigidas a todos estos factores. Presentamos algunas pautas que podrían ser importantes para promover un envejecimiento activo y actividades preventivas que podrán ser aplicadas según el contexto particular de cada persona.

  2. Lepidopterismo por Hylesia Nigricans (mariposa negra: Investigación y acción preventiva en Buenos Aires Lepidopterism due to the butterfly Hylesia nigricans: Preventive research-intervention in Buenos Aires

    Directory of Open Access Journals (Sweden)

    Ascar D. Salomón

    2005-06-01

    Full Text Available En el barrio El Pato, municipio de Berazategui, provincia de Buenos Aires, se realizó una investigación-acción preventiva contra la «mariposa negra» Hylesia nigricans, luego del aumento de consultas espontáneas por dermatitis inespecífica. La incidencia pre-intervención, durante el verano del año 2001, se estimó mediante una encuesta semiestructurada. En noviembre de 2002 se roció con Bacillus thuringiensis el arbolado público, evaluándose su efecto insecticida en campo y en laboratorio. El impacto se estimó mediante una encuesta post-intervención en marzo de 2002. La distribución por edad, signos clínicos, persistencia (11 días y estacionalidad de los casos (enero-febrero 2001 fue consistente con dermatitis por H. nigricans. La mortalidad de larvas a las 96 horas del rociado fue del 100%. Las tasas de incidencia de dermatitis antes y después de la intervención fueron de 10.3% y 1.8% respectivamente. La acción coordinada de agentes nacionales, provinciales y locales permitió identificar el problema, diseñar investigaciones operacionales, y aplicar una estrategia de control preventivo, transferible por sus mismos efectores a la comunidad.A preventive research-intervention against the butterfly Hylesia nigricans was performed after an increase in spontaneous reports of nonspecific dermatitis in El Pato neighbourhood, Berazategui County, Buenos Aires Province. The overall pre-intervention incidence was estimated with a semistructured questionnaire carried out during March 2001. The trees in the street were sprayed with Bacillus thuringiensis, and the insecticide effect was evaluated both in the field and in the laboratory (November 2002. The impact was estimated with a post-intervention questionnaire during March 2002. The age distribution, clinical appearance, persistence (11 days and seasonality (January-February 2001 of the cases were consistent with dermatitis due to H. nigricans. The mortality of larvae 96 h after the

  3. Conservación preventiva y temperatura de superficie en obras pictóricas en exposición

    Directory of Open Access Journals (Sweden)

    María del Carmen Bellido-Márquez

    2013-12-01

    Full Text Available Las condiciones medioambientales en que se encuentran las obras de arte son un factor que determina su conservación. Optimizar estos parámetros beneficia la conservación de las mismas. El Centro José Guerrero (Granada cuenta con una colección permanente (gráfica y pictórica del pintor José Guerrero, sobre la que se ha realizado el estudio que nos ocupa. El edifico no ofrece una temperatura similar en sus espacios expositivos, ni la temperatura de superficie de los cuadros en exposición es homogénea en toda su extensión, lo que se ha podido comprobar mediante técnicas analíticas de temperatura de superficie, que han reflejado con claridad las condiciones reales de temperatura de las obras, que también resultan ser diferentes a las mediciones térmicas globales del ambiente de las salas, con las consiguientes alteraciones físicas y químicas que este fenómeno puede originar en los materiales de los trabajos artísticos. Debido a ello, razón, este hecho debe ser valorado, con la intención de evitarlo o minimizarlo convenientemente.

  4. ambulation during labor with combined spinal-epidural analgesia

    African Journals Online (AJOL)

    Adele

    cations including aphasia, dysphagia, altered level of consciousness, high sensory block, respiratory depression, and respiratory arrest, following induction of CSEA for labor pain. Conclusion. In summary, the CSEA technique for ambulatory analgesia in labor has a good record of efficacy and safety and can be ac-.

  5. Analgesia in the horse, assessing and treating pain in equines

    NARCIS (Netherlands)

    Loon, Thijs van

    This review focuses on pain and nociception in horses and is based on the PhD thesis “Analgesia in the Horse, various approaches for assessment and treatment of pain and nociception in equines” by J.P.A.M. van Loon. Apart from a scientific review of the related literature, a multi-disciplinary

  6. Southern African Journal of Anaesthesia and Analgesia - Vol 20, No ...

    African Journals Online (AJOL)

    Effectiveness of tramadol/paracetamol compared with etoricoxib as postoperative analgesia in daycare surgery · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Choy Y. Choy, Adnan Isquandar, 155-159. http://dx.doi.org/10.1080/22201173.2014.936750 ...

  7. Safety and efficacy of procedural sedation and analgesia (PSA ...

    African Journals Online (AJOL)

    Safety and efficacy of procedural sedation and analgesia (PSA) conducted by medical officers in a level 1 hospital in Cape Town. ... Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference ...

  8. Caudal analgesia for herniotomy: Comparative evaluation of two ...

    African Journals Online (AJOL)

    Objective: There is currently a wide range of volume schemes for bupivacaine caudal anesthesia. This study evaluated the quality of caudal analgesia achieved with a dosing scheme of 0.75 ml/kg compared with 0.5 ml/kg of 0.25% plain bupivacaine for herniotomy. Methods: After the institutional approval, American Society ...

  9. Side effects of pain and analgesia in animal experimentation.

    Science.gov (United States)

    Jirkof, Paulin

    2017-03-22

    This review highlights selected effects of untreated pain and of widely used analgesics such as opioids, non-steroid anti-inflammatory drugs and antipyretics, to illustrate the relevance of carefully planned, appropriate and controlled analgesia for greater reproducibility in animal experiments involving laboratory rodents.

  10. Information Models of Acupuncture Analgesia and Meridian Channels

    Directory of Open Access Journals (Sweden)

    Chang Hua Zou

    2010-12-01

    Full Text Available Acupuncture and meridian channels have been major components of Chinese and Eastern Asian medicine—especially for analgesia—for over 2000 years. In recent decades, electroacupuncture (EA analgesia has been applied clinically and experimentally. However, there were controversial results between different treatment frequencies, or between the active and the placebo treatments; and the mechanisms of the treatments and the related meridian channels are still unknown. In this study, we propose a new term of infophysics therapy and develop information models of acupuncture (or EA analgesia and meridian channels, to understand the mechanisms and to explain the controversial results, based on Western theories of information, trigonometry and Fourier series, and physics, as well as published biomedical data. We are trying to build a bridge between Chinese medicine and Western medicine by investigating the Eastern acupuncture analgesia and meridian channels with Western sciences; we model the meridians as a physiological system that is mostly constructed with interstices in or between other physiological systems; we consider frequencies, amplitudes and wave numbers of electric field intensity (EFI as information data. Our modeling results demonstrate that information regulated with acupuncture (or EA is different from pain information, we provide answers to explain the controversial published results, and suggest that mechanisms of acupuncture (or EA analgesia could be mostly involved in information regulation of frequencies and amplitudes of EFI as well as neuronal transmitters such as endorphins.

  11. Effect of irradiation on analgesia induced by morphine and endorphin

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Kyu; Lee, Byoung Hun; Hyun, Soung Hee; Chung, Ki Myung [KAERI, Daejeon (Korea, Republic of)

    2003-07-01

    Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a {sup 60}Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms.

  12. Effect of irradiation on analgesia induced by morphine and endorphin

    International Nuclear Information System (INIS)

    Kim, Jin Kyu; Lee, Byoung Hun; Hyun, Soung Hee; Chung, Ki Myung

    2003-01-01

    Morphine and endorphin administered intracerebroventricularly (i.c.v.) produce analgesia by activating different descending pain inhibitory systems. Gamma irradiation attenuates the acute analgesic action of i.c.v. injected morphine in mice. This study was done to investigate the effect of-irradiation on the analgesia produced by i.c.v. injected morphine and endorphin in male ICR mice. In one group, mice were exposed to whole-body irradiation at a dose of 5 Gy from a 60 Co source and the analgesic effects were tested 5, 30, 60, 90 and 180 min after irradiation using the acetic acid-induced writhing test. The analgesic effect was produced time-dependently and reached its maximum at 90 min after irradiation. Thus, time was fixed in the following studies. In another group, mice were irradiated with 5 Gy and tested 90 minutes later for analgesia produced by i.c.v. administration of morphine or endorphin. Irradiation significantly potentiated the analgesia produced by endorphin. However, the antinociception produced by morphine was not affected by irradiation. These results support the hypothesis that morphine and endorphin administered supraspinally produce antinocieception by different neuronal mechanisms

  13. Analgesia and anesthesia for neonates : Study design and ethical issues

    NARCIS (Netherlands)

    Anand, KJS; Aranda, JV; Berde, CB; Buckman, S; Capparelli, EV; Carlo, WA; Hummel, P; Lantos, P; Johnston, CC; Lehr, VT; Lynn, AM; Oberlander, TF; Raju, TNK; Soriano, SG; Taddio, A; Walco, GA; Maxwell, L.G.

    Objective: The purpose of this article is to summarize the clinical, methodologic, and ethical considerations for researchers interested in designing future trials in neonatal analgesia and anesthesia, hopefully stimulating additional research in this field. Methods: The MEDLINE, PubMed, EMBASE, and

  14. Analgesia pós-operatória multimodal em cirurgia ginecológica videolaparoscópica ambulatorial: comparação entre parecoxib e tenoxicam Analgesia pos-operatoria multimodal en cirugía ginecológica videolaparoscópica ambulatorial: comparación entre parecoxib y tenoxican Multimodal analgesia in outpatient videolaparoscopic gynecologic surgery: comparison between parecoxib and tenoxicam

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2005-04-01

    tenoxican venoso en un estudio doblemente encubierto. MÉTODO: Fueron estudiadas prospectivamente 60 pacientes divididas de forma aleatoria en 2 grupos. Todas recibieron sedación pre-operatoria con midazolan. Un de los grupos (P recibió antes de iniciar la cirugía 40 mg de parecoxib y en el otro (T 20 mg de tenoxican. En la sala de operación fue hecha raquianestesia con bupivacaína y sufentanil. La analgesia pos-operatoria fue evaluada mediante la intensidad del dolor con escalas verbal y visual, localización del dolor (incisional, visceral, en el hombro y el consumo de analgésicos suplementares. Fueron registrados los efectos colaterales adversos La satisfacción de la paciente con la técnica fue pesquisada. RESULTADOS: La calidad analgésica fue excelente, con 76% de las pacientes del grupo P y 83% de las pacientes del grupo T sin queja de dolor y tampoco el uso de analgésicos en el pos-operatorio. No hubo diferencia entre los grupos en todos los criterios y períodos de evaluación analgésica. La incidencia de efectos adversos fue pequeña, no obstante, prurito de intensidad leve y de corta duración ocurrió frecuentemente. Todas las pacientes quedaron satisfechas o también muy satisfechas con la técnica empleada. CONCLUSIONES: Una técnica de analgesia multimodal, con un componente de anestésico local y opioide por vía subaracnóidea asociado con AINE venoso produce analgesia pos-operatoria de excelente calidad con pocos efectos colaterales adversos en cirugía videolaparoscópica ginecológica ambulatorial. La elección del AINE no parece importante para la obtención de estos resultados.BACKGROUND AND OBJECTIVES: The quality of postoperative analgesia in patients submitted to outpatient videolaparoscopic gynecologic surgery was evaluated by comparing the effects of intravenous parecoxib and tenoxicam in a double-blind study. METHODS: Participated in this prospective study 60 patients who were randomly divided into two groups. All patients were

  15. Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

    Science.gov (United States)

    Shrestha, Bikash; Devgan, Amit; Sharma, Mukti

    2014-12-10

    Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

  16. Effect of epidural analgesia on labor and its outcomes

    International Nuclear Information System (INIS)

    Fawad, A.; Naz, H.; Nelofar, T.; Abbasi, A.U.N.

    2015-01-01

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

  17. Patient-controlled analgesia after coronary bypass: Remifentanil or sufentanil?

    Science.gov (United States)

    Alavi, Seyed Mostafa; Ghoreishi, Seyed Mohammadmehran; Chitsazan, Mitra; Ghandi, Iman; Fard, Alireza Jahangiri; Hosseini, Seyed Saeed; Mahjoobifard, Maziar; Fani, Kamal

    2014-07-01

    adequate pain control after cardiac surgery is mandatory to reduce its remarkable morbidity. In this study, we aimed to compare the efficacy of patient-controlled analgesia with remifentanil or sufentanil for pain management after coronary artery bypass grafting. 249 patients who underwent coronary artery bypass were randomly assigned to receive patient-controlled analgesia with remifentanil or sufentanil during the first 24 h postoperatively. Pain intensity during patient-controlled analgesia was assessed using 4 different pain rating scales. patients given remifentanil had lower Visual Analog Scale scores at 24 h compared to those given sufentanil (p = 0.002). The Numeric Rating Scale at 24 h was also significantly lower in patients using remifentanil (p = 0.004). The Faces Pain Scale scores at 4, 18, and 24 h were significantly lower in patients using remifentanil compared to those using sufentanil (p = 0.045, 0.036, and 0.011, respectively). No significant differences between groups were seen in the pain intensity assessed by the Behavior Rating Scale at any time point during the first 24 h postoperatively. our study showed that both remifentanil and sufentanil patient-controlled analgesia can provide acceptable analgesia after coronary artery bypass. The difference between their efficacies was inconspicuous until 24 h postoperatively. Remifentanil seems to result in better pain relief at 24 h postoperatively. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  18. EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

    Science.gov (United States)

    Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

    2015-01-01

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of. 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.

  19. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  20. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    Science.gov (United States)

    Fanning, Rebecca A; Briggs, Liam P; Carey, Michael F

    2009-03-01

    The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  1. Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia.

    Science.gov (United States)

    Ayad, Sabry; Babazade, Rovnat; Elsharkawy, Hesham; Nadar, Vinayak; Lokhande, Chetan; Makarova, Natalya; Khanna, Rashi; Sessler, Daniel I; Turan, Alparslan

    2016-01-01

    Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (pconsumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and continuous epidural analgesia were similar in terms of pain and opioid consumption, and not worse in pain compared with IV PCA

  2. Evaluación ergonómica de puesto con pantalla de visualización

    OpenAIRE

    Guerrero, Francisco Javier

    2012-01-01

    Para completar el Máster en Prevención de Riesgos Laborales se necesita elaborar un Trabajo Final basado en una de las especialidades técnicas preventivas. El Trabajo que se presenta versa sobre la especialidad de Ergonomía y Psicosociología Aplicada y dentro de ésta se ha optado por la realización de una evaluación ergonómica sobre un puesto de trabajo que utiliza pantalla de visualización de datos. El centro de trabajo donde se ubica el puesto es un edificio con oficinas y otros servi...

  3. Posterior paramedian subrhomboidal analgesia versus thoracic epidural analgesia for pain control in patients with multiple rib fractures.

    Science.gov (United States)

    Shelley, Casey L; Berry, Stepheny; Howard, James; De Ruyter, Martin; Thepthepha, Melissa; Nazir, Niaman; McDonald, Tracy; Dalton, Annemarie; Moncure, Michael

    2016-09-01

    Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA). This prospective study included 30 patients with three or more acute rib fractures admitted to a Level I trauma center. Thoracic epidural analgesia or PoPS catheters were placed, and local anesthesia was infused. Data were collected including patients' pain level, adjunct morphine equivalent use, adverse events, length of stay, lung volumes, and discharge disposition. Nonparametric tests were used and two-sided p Pain rating was lower in the PoPS group (2.5 vs. 5; p = 0.03) after initial placement. Overall, there was no other statistically significant difference in pain control or use of oral morphine adjuncts between the groups. Hypotension occurred in eight patients, 75% with TEA and only 25% with PoPS. No difference was found in adverse events, length of stay, lung volumes, or discharge disposition. In patients with rib fractures, PoPS analgesia may provide pain control equivalent to TEA while being less invasive and more readily placed by a variety of hospital staff. This pilot study is limited by its small sample size, and therefore additional studies are needed to prove equivalence of PoPS compared to TEA. Therapeutic study, level IV.

  4. Continuous versus patient-controlled epidural analgesia for labour analgesia and their effects on maternal motor function and ambulation.

    Science.gov (United States)

    Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert

    2014-01-01

    The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

  5. Vectores recombinantes basados en el virus modificado de ankara (MVA) como vacunas preventivas y terapéuticas contra el SIDA

    OpenAIRE

    Heeney, Jonathan L.; Mooij, Petra; Nájera García, José Luis; Jiménez, Victoria; Esteban, Mariano; Gómez, Carmen E.

    2005-01-01

    Vectores Recombinantes basados en el Virus Modificado de Ankara (MVA) como Vacunas Preventivas y Terapéuticas contra el SIDA. Losvirus recombinantes de la invención contienen secuencias que se encuentran insertadas en el mismo sitio de inserción del MVA y permiten la expresión simultánea de varios antígenos, una proteína Env del VIH-I consistente en una proteína gpl20 carente de secuencias correspondientes a la proteína gp41, y una proteína quiméricade fusión de Gag, Pol y Nef. Son virus esta...

  6. Modelos de atracción de los y las adolescentes. Contribuciones desde la socialización preventiva de la violencia de género

    OpenAIRE

    Padrós Cuxart, María; Aubert Simon, Adriana

    2010-01-01

    [ES] La violencia de género está también presente en las relaciones adolescentes. En España, en el año 20072, más de 4.000 chicas menores de 20 años denunciaron a su pareja o ex pareja por malos tratos. Desde la educación, se nos plantea el reto de desarrollar acciones preventivas en sus primeras relaciones. En la investigación que presentamos hemos analizado los modelos de atracción de los y las adolescentes. Los resultados destacan que los chicos y chicas se están socializando en u...

  7. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome.

    Science.gov (United States)

    Hasegawa, Junichi; Farina, Antonio; Turchi, Giovanni; Hasegawa, Yuko; Zanello, Margherita; Baroncini, Simonetta

    2013-02-01

    We aimed to clarify whether the short-term adverse neonatal outcomes associated with epidural analgesia are due to the epidural analgesia itself or to the instrumental delivery. A retrospective case-control study was conducted to evaluate the relationship between epidural analgesia, labor length, and perinatal outcomes. A total of 350 pregnant women at term who delivered under epidural analgesia (cases) were compared with 1400 patients without epidural analgesia (controls). Vacuum extraction (6.5 vs. 2.9 %) and cesarean section (19.9 vs. 11.1 %) were more frequently performed in the cases than controls (p neonatal variables stratified by mode of delivery were not different in cases and controls, except for a slightly lower umbilical arterial pH in spontaneous delivery for the cases group. However, the Apgar scores and umbilical arterial pH were significantly lower in the neonates delivered by vacuum extraction compared with those in the neonates delivered by spontaneous delivery or cesarean section, regardless of whether epidural analgesia was performed. A multivariable analysis showed that vacuum extraction much more consistently affected the arterial pH than the analgesia itself (the β coefficients were -0.036 for epidural analgesia vs. -0.050 for vacuum extraction). Epidural analgesia was associated with slowly progressing labor, thus resulting in an increased rate of instrumental delivery. This instrumental delivery appears to adversely affect the neonatal outcomes more strongly than the analgesia itself.

  8. Evaluación de Riesgos y Medidas Preventivas para la Seguridad en el Laboratorio de Salud Pública.

    OpenAIRE

    Caro-Bonell, Alejandra Marcella

    2013-01-01

    Dentro del laboratorio de Salud Publica llegan muestras de toda la ciudad, para ser analizadas por el personal del laboratorio, de allí la importancia de gestionar los riesgos derivados de la labor diaria dentro de las instalaciones. Se han presentado diversas patologías en los empleados del laboratorio, y se evidencia que no se ha manejado una gestión del riesgo para las operaciones diarias del mismo, y se plantea la realización del mapa de riesgos ocupacionales con énfasis en se...

  9. Fatores relacionados ao uso de analgesia sistêmica em neonatologia Factors related to use of systemic analgesia in neonatology

    Directory of Open Access Journals (Sweden)

    Carmen Lúcia Guimarães de Aymar

    2008-12-01

    Full Text Available O objetivo desse trabalho foi realizar uma revisão da literatura sobre o histórico e o estágio atual de conhecimento sobre a analgesia sistêmica em neonatologia e os fatores que influenciam a sua utilização. Foi realizada busca de artigos científicos através das bases dados do MEDLINE, SciELO e LILACS com as palavras chave: analgesia, analgésicos sistêmicos, dor, neonatologia, recém-nascido, unidade de terapia intensiva e unidade de terapia intensiva neonatal, além de pesquisa adicional em bancos de dados de dissertações, teses e livros texto. A literatura consultada revela que a analgesia não é uma prática rotineira nas unidades de terapia intensiva neonatal, de uma forma geral, apesar dos inúmeros estudos demonstrando a importância do tema. Apesar de ser o alívio da dor um dos princípios básicos da medicina, de envolver questões éticas e humanitárias, e de estarem disponíveis atualmente vários guias práticos e consensos a respeito do manejo da dor no neonato de risco, os resultados encontrados no presente estudo estão muito aquém das recomendações atuais, tornando-se necessária uma intervenção urgente para reverter a situação observada.The purpose of this paper was to carry out a review of literature on the history and current stage of the knowledge of systemic analgesia in neonatology and the factors influencing its use. A search for scientific articles was made in the MEDLINE, SciELO and LILACS databases using the keywords: analgesia, systemic analgesics, pain, neonatology, newborn, intensive care units and neonatal intensive care units. Additional research was made on dissertations and thesis databanks as well as text books. Literature consulted disclosed that, in general, analgesia is not a routine practice in neonatal intensive care units, despite the numerous studies demonstrating its importance. Although pain relief is a basic principle of medicine, involving ethic and humanitarian issues and despite

  10. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

    2011-01-01

    Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...... bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...

  11. Infant feeding and analgesia in labour: the evidence is accumulating

    Directory of Open Access Journals (Sweden)

    Jordan Sue

    2006-12-01

    Full Text Available Abstract The interesting and important paper by Torvaldsen and colleagues provides further circumstantial evidence of a positive association between intrapartum analgesia and feeding infant formula. Not all research supports this association. Before 'failure to breastfeed' can be adjudged an adverse effect of intrapartum analgesia, the research evidence needs to be considered in detail. Examination of the existing evidence against the Bradford-Hill criteria indicates that the evidence is not yet conclusive. However, the difficulties of obtaining funding and undertaking large trials to explore putative adverse drug reactions in pregnant women may mean that we shall never have conclusive evidence of harm. Therefore, reports of large cohort studies with regression models, as in the paper published today, assume a greater importance than in other areas of investigation. Meanwhile, women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour.

  12. Acupuncture Anesthesia and Analgesia for Clinical Acute Pain in Japan

    Directory of Open Access Journals (Sweden)

    Reina Taguchi

    2008-01-01

    Full Text Available Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body's endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post- operative pain (POP, neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth.

  13. [Obstetric analgesia and anesthesia in Switzerland in 1999].

    Science.gov (United States)

    Zwetsch-Rast, G; Schneider, M C; Siegemund, M

    2002-02-01

    This survey investigated the common practice of obstetric analgesia and anaesthesia in Swiss hospitals and evaluated the influence of the Swiss interest group for obstetric anaesthesia. In March 1999 we submitted 145 questionnaires to all Swiss hospitals providing an obstetric service. The rate of epidural analgesia (EA) was higher in large hospitals (> 1,000 births/year) than in small services. EA was maintained by continuous infusion techniques in 53% of the responding hospitals. For elective caesarean section, spinal anaesthesia (SA) and EA were performed in 77% and 16% of the patients, respectively. General anaesthesia (5%) was only used in small hospitals (interest group for obstetric anaesthesia, as well as the expectations of pregnant women, increased the numbers of regional anaesthesia compared with the first survey in 1992.

  14. Intrapartum analgesia as a condition of human satisfaction at hospital

    Directory of Open Access Journals (Sweden)

    Concetta Polizzi

    2013-06-01

    Full Text Available The study investigates parturients’ satisfaction with intrapartum analgesia. It aims to assess their opinions about hospital and health staff involved in delivery, besides investigating emotional control, locus control and bond between mothers and their newborn infants. A multidimensional approach has been used to investigate the variable of woman as a person, the variable of context and the variable of bond with the newborn infant. The study was conducted according to a quasi-experimental design, with a control group. The study was performed within the Analgesia and Intensive Care Operational Unit of the Maternal-Infant Department of the P. Giaccone University General Hospital of Palermo. It involved 60 women subdivided into two groups of 30 women each, the experimental group (women who requested intrapartum analgesia called the A group, and the control group (women who refused it called the B group. The following tools were administered: the STAI-Y (State-Trait Anxiety Inventory, form Y scale; the Depression Questionnaire of CBA (Cognitive Behavioural Assessment scale; the Locus of Control questionnaire; and an interview designed for the purpose. The experimental A group women exhibited lower levels of state anxiety and depression post-partum than those of the control B group; moreover, the women in the A group exhibited higher levels of external locus of control and evaluated delivery more positively than those of the B group. There were no significant differences with regard to the relationship with their newborn infants. The study shows that intrapartum analgesia provides hospitals with the possibility to satisfy women’s needs for safety and well-being.

  15. The Neuroanatomy of Sexual Dimorphism in Opioid Analgesia

    Science.gov (United States)

    2014-04-13

    2012 for review). Studies utilizing orofacial , somatosensory or visceral pain assays typically report that morphine produces a significantly greater...Review The neuroanatomy of sexual dimorphism in opioid analgesia Dayna R. Loyd a, Anne Z. Murphy b,⁎ a Pain Management Research Area, United States...online 13 April 2014 Keywords: Pain Periaqueductal gray Morphine Mu opioid receptor The influence of sex has been neglected in clinical studies on pain

  16. Prehospital Use of Ketamine in Battlefield Analgesia 2012-03

    Science.gov (United States)

    2012-03-08

    Breathing a. In a casualty with progressive respiratory distress and known or suspected torso trauma , consider a tension pneumothorax and... pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch needle/catheter unit inserted in the second...Military Advanced Regional Anesthesia and Analgesia Handbook, U.S. Special Operations Command Tactical Trauma Protocols (since 2008), Army Ranger Medic

  17. Labour analgesia with intrathecal fentanyl decreases maternal stress.

    Science.gov (United States)

    Cascio, M; Pygon, B; Bernett, C; Ramanathan, S

    1997-06-01

    Lumbar epidural analgesia (LEA) decreases maternal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephrine (Epi) and norepinephrine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA. Twenty-four healthy women in active labour received either 25 micrograms ITF (n = 12) or epidural lidocaine 1.5% (n = 12) for analgesia. Venous blood samples were collected before anaesthesia and at five minute intervals for 30 min following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores (VAS) to pain and pruritus were recorded at the same time. Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyl(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01). We conclude that ITF is as effective as LEA in producing pain relief in the labouring patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epinephrine concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamine during labour.

  18. [Sedation and analgesia practices among Spanish neonatal intensive care units].

    Science.gov (United States)

    Avila-Alvarez, A; Carbajal, R; Courtois, E; Pertega-Diaz, S; Muñiz-Garcia, J; Anand, K J S

    2015-08-01

    Pain management and sedation is a priority in neonatal intensive care units. A study was designed with the aim of determining current clinical practice as regards sedation and analgesia in neonatal intensive care units in Spain, as well as to identify factors associated with the use of sedative and analgesic drugs. A multicenter, observational, longitudinal and prospective study. Thirty neonatal units participated and included 468 neonates. Of these, 198 (42,3%) received sedatives or analgesics. A total of 19 different drugs were used during the study period, and the most used was fentanyl. Only fentanyl, midazolam, morphine and paracetamol were used in at least 20% of the neonates who received sedatives and/or analgesics. In infusions, 14 different drug prescriptions were used, with the most frequent being fentanyl and the combination of fentanyl and midazolam. The variables associated with receiving sedation and/or analgesia were, to have required invasive ventilation (P3 (P=.023; OR=2.26), the existence of pain evaluation guides in the unit (Pneonates admitted to intensive care units receive sedatives or analgesics. There is significant variation between Spanish neonatal units as regards sedation and analgesia prescribing. Our results provide evidence on the "state of the art", and could serve as the basis of preparing clinical practice guidelines at a national level. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. Perinatal and neonatal use of sedation and analgesia.

    Science.gov (United States)

    McPherson, Christopher; Inder, Terrie

    2017-10-01

    Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus. Although experimental data raise concerns, human data are reassuring and future research may focus on neuroprotective adjuncts in the setting of repeated or prolonged anesthetic exposures. Opioid analgesia is standard of care for preterm infants undergoing major procedures including invasive surgery and endotracheal intubation. The use of opioids for agitation resulting from mechanical ventilation is controversial, but prevalent. Randomized and retrospective studies detect short-term toxicity with inconclusive long-term impact, suggesting the need to explore alternative therapies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Clonidina e dexmedetomidina por via peridural para analgesia e sedação pós-operatória de colecistectomia Clonidina y dexmedetomidina por vía peridural para analgesia y sedación pós-operatoria de colecistectomía Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation

    Directory of Open Access Journals (Sweden)

    Antônio Mauro Vieira

    2004-08-01

    -adrenérgicos que, cuando administrados por vía peridural, poseen propiedades analgésicas y potencializan los efectos de los anestésicos locales. La actual pesquisa objetiva evaluar la analgesia y la sedación causadas por la clonidina o dexmedetomidina asociadas a la ropivacaína, por vía peridural, en el pós-operatorio de colecistectomía por vía subcostal. MÉTODO: Participaron del estudio aleatorio y duplamente encubierto 40 pacientes, de ambos sexos, con edad variando de 18 a 50 años, peso entre 50 y 100 kg, estado físico ASA I y II, sometidos a colecistectomía por vía subcostal, los cuales fueron distribuidos en dos grupos: clonidina (GC, en que fue administrada clonidina (1 ml = 150 µg asociada a ropivacaína a 0,75% (20 ml por vía peridural; dexmedetomidina (GD, en que fue inyectada dexmedetomidina (2 µg.kg-1 asociada a ropivacaína a 0,75% (20 ml por vía peridural. La analgesia y la sedación fueron observadas 2, 6 y 24 horas después del término de la anestesia. RESULTADOS: Ocurrió sedación después de 2 y 6 horas en ambos grupos, siendo que hubo diferencia estadística significante entre los tiempos de 2 y 6 horas en el grupo dexmedetomidina. Hubo analgesia en ambos grupos, especialmente después de 2 y 6 horas. Fue detectada diferencia estadística significante entre los tiempos de 2, 6 y 24 horas en el grupo dexmedetomidina; en el grupo clonidina esa diferencia estadística significante fue observada entre los tiempos de 2 y 6 horas y entre 2 y 24 horas. CONCLUSIONES: Los resultados permitieron concluir que la clonidina o la dexmedetomidina asociadas a ropivacaína a 0,75% aseguraron analgesia y sedación en los tiempos de observación de 2 y 6 horas después del término de la anestesia, en los pacientes sometidos a la colecistectomia por vía subcostal y que la clonidina promueve analgesia más prolongada.BACKGROUND AND OBJECTIVES: Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate

  1. Parameter Optimization Analysis of Prolonged Analgesia Effect of tDCS on Neuropathic Pain Rats

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    Hui-Zhong Wen

    2017-06-01

    Full Text Available Background: Transcranial direct current stimulation (tDCS is widely used to treat human nerve disorders and neuropathic pain by modulating the excitability of cortex. The effectiveness of tDCS is influenced by its stimulation parameters, but there have been no systematic studies to help guide the selection of different parameters.Objective: This study aims to assess the effects of tDCS of primary motor cortex (M1 on chronic neuropathic pain in rats and to test for the optimal parameter combinations for analgesia.Methods: Using the chronic neuropathic pain models of chronic constriction injury (CCI, we measured pain thresholds before and after anodal-tDCS (A-tDCS using different parameter conditions, including stimulation intensity, stimulation time, intervention time and electrode located (ipsilateral or contralateral M1 of the ligated paw on male/female CCI models.Results: Following the application of A-tDCS over M1, we observed that the antinociceptive effects were depended on different parameters. First, we found that repetitive A-tDCS had a longer analgesic effect than single stimulus, and both ipsilateral-tDCS (ip-tDCS and contralateral-tDCS (con-tDCS produce a long-lasting analgesic effect on neuropathic pain. Second, the antinociceptive effects were intensity-dependent and time-dependent, high intensities worked better than low intensities and long stimulus durations worked better than short stimulus durations. Third, timing of the intervention after injury affected the stimulation outcome, early use of tDCS was an effective method to prevent the development of pain, and more frequent intervention induced more analgesia in CCI rats, finally, similar antinociceptive effects of con- and ip-tDCS were observed in both sexes of CCI rats.Conclusion: Optimized protocols of tDCS for treating antinociceptive effects were developed. These findings should be taken into consideration when using tDCS to produce analgesic effects in clinical

  2. Consumo de sustancias psicoactivas en estudianets de magisterio y sus creencias acerca de la educación preventiva

    Directory of Open Access Journals (Sweden)

    Manuel Fernández Cruz

    Full Text Available Resumen La realización de programas escolares de prevención de consumo de drogas se ha demostrado eficaz en el control de hábitos de adicción en la población juvenil. El éxito de los programas preventivos descansa, en buena parte, en la capacitación de los docentes que los desarrollan y sus propias creencias sobre el consumo de drogas. Otro factor que puede estar relacionado con el éxito de los programas, es la experiencia del propio docente en el consumo de sustancias psicoactivas. En este artículo se explora la relación entre hábitos de consumo de tabaco, alcohol y drogas ilegales de futuros docentes (estudiantes de magisterio de la Universidad de Granada y las creencias falsas sobre prevención de la drogadicción en la escuela que mantienen.

  3. SALUD DE HATO DEFINICIÓN Y ESTRATEGIAS PARA EL ESTABLECIMIENTO DE PROGRAMAS DE MEDICINA VETERENARIA PREVENTIVA

    Directory of Open Access Journals (Sweden)

    JL Zambrano

    2009-01-01

    Full Text Available El objetivo principal de un programa de salud de hato en animales de producción es el mantenimiento de la salud animal y la producción en el nivel más eficiente que ofrezca rentabilidad económica competitiva al productor. Algunos objetivos secundarios igualmente importante, incluyen proporcionar bienestar animal, garantizar la calidad de los productos producidos, minimizar el impacto medio ambiental generado por los residuos de origen animal, la prevención de las enfermedades zoonóticas y disminución de la presentación de contaminantes y residuos en productos de origen animal. En todos los programas de medicina de la producción, se deben establecer objetivos claros. Así mismo, se deben comparar los niveles reales de eficiencia con los objetivos previamente planteados; la diferencia corresponde a las deficiencias en la productividad. a través de utilizar un sistema de problema orientado se busca identificar las problemáticas de salud de forma sistemática, con el objetivo de establecer e implementar los correctivos necesarios, los cuales deben ser adecuadamente monitoreados. Para tal fin, la epidemiología veterinaria se ha convertido en una herramienta cuantitativa muy importante para la evaluación y el seguimiento de los problemas de salud en los programas de salud de hato. Los objetivos del presente documento son discutir algunos de los principios básicos de la salud del hato y presentar un enfoque práctico utilizar herramientas epidemiológicas en la investigación de los problemas de salud de hato.

  4. Comparative Analysis of Different Types of Analgesia in Patients after Surgical Correction of Scoliotic Spinal Deformity

    Directory of Open Access Journals (Sweden)

    M.A. Georgiyants

    2013-03-01

    Full Text Available A comparative study of epidural analgesia and anesthesia using opiates after surgical interventions for spinal scoliosis in children has beem carried out. Patients were divided into 2 groups. In the first one postoperative analgesia was carried out by intramuscular injection of promedol, in second one epidural analgesia was used with the constant introduction of ropivacaine. The authors studied the effect of these techniques on hemodynamics, the analysis of the subjective perception of pain by patients.

  5. Stereotactic core biopsy of an impalpable screen-detected breast lesion using acupuncture-analgesia

    OpenAIRE

    English, R E; Chen, J H

    2010-01-01

    Chinese acupuncture-analgesia is used for pain management during various surgical procedures. Over the past 40 years this approach has been introduced in many countries and has been particularly helpful in the investigation and treatment of patients who are unable to tolerate conventional analgesia. We report here the case of a woman with a 17-year history of myalgic encephalitis who underwent a stereotactic core biopsy of the breast under acupuncture-analgesia. A planning session was needed ...

  6. Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2009-01-01

    Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ìg.ml-1 of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

  7. Intraoperative local infiltration analgesia for early analgesia after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial

    DEFF Research Database (Denmark)

    Lunn, Troels H; Husted, Henrik; Solgaard, Søren

    2011-01-01

    : High-volume local infiltration analgesia (LIA) is widely applied as part of a multimodal pain management strategy in total hip arthroplasty (THA). However, methodological problems hinder the exact interpretation of previous trials, and the evidence for LIA in THA remains to be clarified....... Therefore, we evaluated whether intraoperative high-volume LIA, in addition to a multimodal oral analgesic regimen, would further reduce acute postoperative pain after THA....

  8. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    International Nuclear Information System (INIS)

    Kooij, Sanne M. van der; Moolenaar, Lobke M.; Ankum, Willem M.; Reekers, Jim A.; Mol, Ben Willem J.; Hehenkamp, Wouter J. K.

    2013-01-01

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were €191 and €355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were €105 and €179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications

  9. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C; Bigler, D

    1988-01-01

    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0.......5% plain bupivacaine 8 ml h-1. Pain, scored on a 5-point scale, and sensory analgesia were assessed hourly for 16 h after skin incision. If sensory analgesia decreased by more than 5 segments from its preoperative level, or if the pain score reached 2 (moderate pain), the patients were removed from...

  10. Impact of Analgesia on the Course of Spontaneous Labor in Women with Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    M. I. Neimark

    2013-01-01

    Full Text Available Objective: to improve the results of spontaneous labor in female patients with diabetes mellitus (DM. Subjects and methods. The results of physiological labor analgesia were analyzed in 140 patients. The parturients were divided into 3 groups: 1 40 parturients in whom analgesia was performed by the intravenous administration of promedol; 2 40 parturients in whom analgesia was done by the fractional administration of 0.2% ropivacaine hydrochloride into the epidural space; 3 40 parturients in whom analgesia was carried out with intravenous paracetamol 2000—3000 mg. In all the patients, the investigators estimated central hemodynamic parameters by echocardiography, the efficiency of labor analgesia according to the scale described by N. N. Rasstrigina and B. V. Shnaider, as well as blood glucose levels, fetal status by a cardiotocographic technique, and neonatal status by Apgar scores at 1 and 5 minutes of life. Results. Analgesia quality assessment established that the best analgesic effect was achieved in the patients in Group 2 where 75.0% of the parturients had 8—10 scores. A comparative analysis of carbohydrate metabolic parameters also ascertained that the most steady-state and physiological glycemic level was recorded in Group 2 patients throughout the study. In addition, epidural analgesia versus other analgesic techniques provides the most steady-state hemodynamic parameters during labor, which promotes improved labor and has a beneficial effect on fetal and neonatal states. Conclusion. Glycemic levels during labor and delivery can be optimized in patients with DM only if adequate analgesia is achieved. By ensuring adequate labor analgesia, epidural analgesia normalizes glycemic and central hemodynamic parameters, favors elimination of delivery abnormalities, and has a beneficial effect on fetal and neonatal states. Key words: epidural analgesia, diabetes mellitus, spontaneous labor.

  11. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol

    Directory of Open Access Journals (Sweden)

    Meena Doda

    2009-01-01

    Full Text Available Thirty children, ASAI-II, aged between 2yrs-5yrs, undergoing sub umbilical operation (inguinal and penile surgery were selected for this double blind study. They were randomly divided in two groups, group Aand group B. Group A(n15 received 0.25%bupivacaine 0.5ml.kg -1 and Group B (n=15 received 0.25% bupivaeaine 0.5ml.kg -1 and tramadol 2mg.kg -1 as single shot caudal block. Postoperative pain was assessed by a modified TPPPS (Toddler-Preschool Postoperative Pain Scale and analgesic given only when the score was more than 3. In the first 24 hrs it was observed that the mean duration of time interval between the caudal block and first dose of analgesic was significantly long(9. lhrs in Group B as compared to Group A (6.3hrs which was much shorter(p< 0.01.There was no significant haemodynamie changes, motor weakness or respiratory depression in both groups. This study con-cluded that addition of tramadol 2mg.kg -1 to caudal 0.25% bupivacaine 0.5ml.kg -1 significantly prolong the duration of postoperative analgesia in children withoutprodueing much adverse effects.

  12. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  13. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    P K Dilesh

    2014-01-01

    Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

  14. Aplicación de la teoría de Peplau en pacientes con diabetes hospitalizados

    Directory of Open Access Journals (Sweden)

    Amalia Priscila Peña-Pita

    2016-12-01

    Full Text Available Objetivo: aplicar la teoría de las relaciones interpersonales de H. Peplau en la atención a pacientes con diabetes mellitus tipo 2, para mostrar su importancia en la práctica clínica hospitalaria y en la prevención de las complicaciones de las personas con esta enfermedad en el hogar. Materiales y Métodos: la experiencia clínica desarrollada se organizó mediante una adaptación de la metodología del marco lógico. La muestra estuvo conformada por cinco pacientes hospitalizados con diabetes mellitus tipo 2. Se tuvo en cuenta variables como la relación profesional de enfermería ­ paciente, nivel de conocimiento y capacidad de cuidado. Las técnicas de recolección de información fueron la entrevista semiestructurada, el taller (intervención educativa y la lista de chequeo. Resultados: la aplicación de la teoría de H. Peplau permitió un acercamiento con los pacientes. A partir de éste, se logró un proceso de educación y seguimiento en el cual la mayoría reconoció la importancia de las prácticas preventivas para el manejo de su condición clínica. Conclusiones: mediante el fortalecimiento de las relaciones interpersonales, orientado por la teoría de H Peplau, la (el enfermera (o y el paciente identifican las necesidades de cuidado con el fin de atenderlas y generar conductas preventivas para evitar complicaciones por la enfermedad. De esta forma, tanto los pacientes como el profesional de enfermería logran tener un mayor nivel de autonomía.

  15. Thoracic epidural analgesia in donor hepatectomy: An analysis.

    Science.gov (United States)

    Koul, Archna; Pant, Deepanjali; Rudravaram, Swetha; Sood, Jayashree

    2018-02-01

    The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214

  16. Modelos de atracción de los y las adolescentes. Contribuciones desde la socialización preventiva de la violencia de género.

    Directory of Open Access Journals (Sweden)

    María Padrós Cuxart

    2010-01-01

    Full Text Available La violencia de género está también presente en las relaciones adolescentes. En España, en el año 2007, más de 4000 chicas menores de 20 años denunciaron a su pareja o expareja por malos tratos. Desde la educación, se nos plantea el reto de desarrollar acciones preventivas en sus primeras relaciones.En la investigación que presentamos hemos analizado los modelos de atracción de los y las adolescentes. Los resultados destacan que los chicos y chicas se están socializando en unas motivaciones y deseos basados en valores tradicionales y desiguales, que se presentan como la causa más profunda sobre la cual se sustenta la violencia de género.---------------------------------------------------------------------Gender violence is also in relationships among adolescent people. In 2007, more than 4000 Spanish girls under 20 reported their partners or ex-partners for gender violence. Education suggests the challenge of developing preventive measures in their first relationships.In the research we are presenting now we have analysed attractiveness models of the teenagers. The results show that girls and boys’ socialization is based on traditional and unequal motivations and values, which are the basis of gender violence.

  17. Adolescência e aids: avaliação de uma experiência de educação preventiva entre pares

    Directory of Open Access Journals (Sweden)

    José Ricardo de Carvalho Mesquita Ayres

    2003-02-01

    Full Text Available Ações preventivas de HIV/AIDS, orientadas à superação dos limites das intervenções de corte comportamentalista, incorporando preocupações com os determinantes sócio-culturais desses comportamentos, constituem hoje uma necessidade e, ao mesmo tempo, uma lacuna. O presente artigo trata de estudo de prevenção no ambiente escolar baseado em estratégia de redução de vulnerabilidade. Constitui um estudo de caso, de corte quanti-quali, que, no contexto desta estratégia, avalia o trabalho de prevenção de aids desenvolvido por alunos multiplicadores em uma escola estadual de ensino médio na periferia da cidade de São Paulo. Entre os resultados, destacam-se: a efetividade da proposta, com ampla aceitação e favorável aproveitamento pelos alunos da escola; o perfil diversificado do aluno multiplicador voluntário; e a tensão entre modelos cognitivo-comportamentalistas e social-construtivistas nos processos educativos concretamente operados pelos multiplicadores. Conclui-se pela possibilidade e interesse da ação de alunos multiplicadores na perspectiva das estratégias de redução de vulnerabilidade, apontando-se a necessidade de desenvolver mecanismos de captação e capacitação capazes de problematizar e superar a tensão apontada.

  18. Postoperative analgesia using diclofenac and acetaminophen in children.

    Science.gov (United States)

    Hannam, Jacqueline A; Anderson, Brian J; Mahadevan, Murali; Holford, Nick H G

    2014-09-01

    Diclofenac dosing in children for analgesia is currently extrapolated from adult data. Oral diclofenac 1.0 mg·kg(-1) is recommended for children aged 1-12 years. Analgesic effect from combination diclofenac/acetaminophen is unknown. Children (n = 151) undergoing tonsillectomy (c. 1995) were randomized to receive acetaminophen elixir 40 mg·kg(-1) before surgery and 20 mg·kg(-1) rectally at the end of surgery with diclofenac suspension 0.1 mg·kg(-1) , 0.5 mg·kg(-1) , or 2.0 mg·kg(-1) before surgery or placebo. A further 93 children were randomized to receive diclofenac 0.1 mg·kg(-1) , 0.5 mg·kg(-1) , or 2.0 mg·kg(-1) only. Postoperative pain was assessed (visual analogue score, VAS 0-10) at half-hourly intervals from waking until discharge. Data were pooled with those from a further 222 children and 30 adults. One-compartment models with first-order absorption and elimination described the pharmacokinetics of both medicines. Combined drug effects were described using a modified EMAX model with an interaction term. An interval-censored model described the hazard of study dropout. Analgesia onset had an equilibration half-time of 0.496 h for acetaminophen and 0.23 h for diclofenac. The maximum effect (EMAX ) was 4.9. The concentration resulting in 50% of EMAX (C50 ) was 1.23 mg·l(-1) for diclofenac and 13.3 mg·l(-1) for acetaminophen. A peak placebo effect of 6.8 occurred at 4 h. Drug effects were additive. The hazard of dropping out was related to pain (hazard ratio of 1.35 per unit change in pain). Diclofenac 1.0 mg·kg(-1) with acetaminophen 15 mg·kg(-1) achieves equivalent analgesia to acetaminophen 30 mg·kg(-1) . Combination therapy can be used to achieve similar analgesia with lower doses of both drugs. © 2014 John Wiley & Sons Ltd.

  19. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...... should aim at including physical rehabilitation programs in the pain treatment regimen....

  20. Epidural postoperative analgesia with tramadol after abdominal hysterectomy

    OpenAIRE

    González-Pérez, E.; González-Cabrera, N.; Nieto-Monteagudo, C. G.; Águila, D. P. C.; Santiago, A.; Rodríguez-Santos, C.

    2006-01-01

    Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular ca...

  1. Early versus late initiation of epidural analgesia for labour.

    Science.gov (United States)

    Sng, Ban Leong; Leong, Wan Ling; Zeng, Yanzhi; Siddiqui, Fahad Javaid; Assam, Pryseley N; Lim, Yvonne; Chan, Edwin S Y; Sia, Alex T

    2014-10-09

    Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials. More recent guidelines suggest that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labour. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. There is no systematically reviewed evidence on the maternal and foetal outcomes and safety of this practice. This systematic review aimed to summarise the effectiveness and safety of early initiation versus late initiation of epidural analgesia in women. We considered the obstetric and fetal outcomes relevant to women and side effects of the treatments, including risk of caesarean section, instrumental birth and time to birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1966 to February 2014), Embase (January 1980 to February 2014) and reference lists of retrieved studies. We included all randomised controlled trials involving women undergoing epidural labour analgesia that compared early initiation versus late initiation of epidural labour analgesia. Two review authors independently assessed trials for inclusion, extracted the data and assessed the trial quality. Data were checked for accuracy. We included nine studies with a total of 15,752 women.The overall risk of bias of

  2. 21 CFR 868.5160 - Gas machine for anesthesia or analgesia.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gas machine for anesthesia or analgesia. 868.5160... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5160 Gas machine for anesthesia or analgesia. (a) Gas machine for anesthesia—(1) Identification. A gas machine for anesthesia is a...

  3. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne

    2005-01-01

    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist...... on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

  4. Patient-Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Patti Kastanias

    2010-01-01

    Full Text Available PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN-administered oral analgesia.

  5. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C; Bigler, D

    1988-01-01

    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

  6. Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

    Science.gov (United States)

    Xu, Zhendong; Su, Jing; Liu, Zhiqiang

    2014-01-01

    Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (Panalgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation. PMID:25386749

  7. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

    NARCIS (Netherlands)

    Carbajal, Ricardo; Eriksson, Mats; Courtois, Emilie; Boyle, Elaine; Avila-Alvarez, Alejandro; Andersen, Randi Dovland; Sarafidis, Kosmas; Polkki, Tarja; Matos, Cristina; Lago, Paola; Papadouri, Thalia; Montalto, Simon Attard; Ilmoja, Mari-Liis; Simons, Sinno; Tameliene, Rasa; van Overmeire, Bart; Berger, Angelika; Dobrzanska, Anna; Schroth, Michael; Bergqvist, Lena; Lagercrantz, Hugo; Anand, Kanwaljeet J. S.; Kiechl-Kohlendorfer, Ursula; Trinkl, Anna; Deindl, Philipp; Wald, Martin; Rigo, Vincent; Dussart, Anneliese; Dierckx, Elke; Coppens, Sophie; Kiilsapaa, Birgit; Metsvaht, Tuuli; Metsäranta, Marjo; Nikolajev, Kari; Saarela, Timo; Peltoniemi, Outi; Tammela, Outi; Lehtonen, Liisa; Savagner, Christophe; Sevestre, Anna; Alexandre, Cénéric; Bouchon-Guedj, Nathalie; Saumureau, Simone; Grosse, Camille; Jouvencel, Philippe; Ramful, Duksha; Clamadieu, Catherine; Mourdie, Julien; Montcho, Yannis; Cambonie, Gilles; Di Maio, Massimo; Patural, Hugues; Asrtuc, Dominique; Norbert, Karine; Bouchera, Kassis; Lang, Mathieu; Galene Gromez, Sophie; Hamon, Isabelle; Nolent, Paul; Ntwari, René-Christian; Lallemant, Carine; Chary Tardy, Anne Cécile; Pelluau, Sonia; Roue, Jean Michel; Picaud, Jean Charles; Camelio, Aurélie; Tourneux, Pierre; Saint-Faust, Marie; Morville, Patrice; David, Alexandra; Theret, Bernard; Frédérique, Martin; Topf, Georg; Menendez-Castro, Ricardo; Fujiwara-Pichler, Erhard; Deeg, Karl Heinz; Anatolitou, Fani; Baroutis, George; Papazafeiratou, Chrissoulan; Giannakopoulou, Christine; Baltogianni, Maria; Delivoria, Varvara; Sterpi, Magdalena; Saklamaki-Kontou, Melpomeni; Dimitriou, Gabriel; Charitou, Antonia; Thomaidou, Agathi; Chatziioannidis, Ilias; Salvanos, Iraklis; Pirelli, Anna; Poggiani, Carlo; Fasolato, Valeria; Cristofori, Gloria; Gomirato, Serena; Allegro, Antonella; Alfiero, Michela; Biban, Paolo; Bertolini, Alessandra; Golin, Rosanna; Franco, Elena; Molinaro, Grazia; Federica, Visintini; Rossini, Roberto; Garetti, Elisabetta; Faraoni, Maddalena; Dani, Carlo; Germini, Cristina; Braguglia, Annabella; Benigni, Gina; Azzali, Adriano; Santa, Barresi; Romoli, Raffaella; Carrera, Giuseppe; Miria, Natile; Savant, Patrizia; Cossu, Maria Antonia; Giancarlo, Gargano; Cassar, Robert; Bos, Annelis; van Kaam, Anton; Brouwer, Mieke; van Lingen, Richard; Bambang Oetomo, Sidarto; Sivertsen, Wiebke; Nakstad, Britt; Solhjell, Kari; Flagstad, Gro; Salvesen, Bodil; Nessestrand, Ingunn A. M.; Nordhov, Marianne; Anderssen, Sven-Harald; Wasland, Kristin; Danielsen, Kåre; Kristoffersen, Laila Marie; Ytterdahl Bergland, Unni; Borghild Stornes, Randi; Andresen, Jannicke; Solberg, Rønnaug; Hochnowski, Kristoffer; Terpinska, Ewa; Kociszewska-Najman, Bozena; Melka, Andrzej; Głuszczak, Ewa; Niezgoda, Anna; Borszewska-Kornacka, Maria Katarzyna; Witwicki, Jacek M.; Korbal, Piotr; Ramos, Helena; Garcia, Pedro; Machado, Cidália; Clemente, Fátima; Costa, Miguel; Trindade, Cristina; Salazar, Anabela; Martins Barroso, Laura; Resende, Cristine; Afonso, Maria Eulàlia; Torres, Jacinto; Maciel, Paula; Nunes, José Luis; Neve Dos Santos, Vera Alexandra; Melgar Bonis, Ana; Euba Lopez, Aintzane; Tapia Collados, Caridad; Jesus Ripalda, María; Solis Sanchez, Gonzalo; Martin Parra, Belén; Botet, Francesc; Fernandez Trisac, Jose Luis; Elorza Fernandez, María Dolores; Arriaga Redondo, María; Bargallo Ailagas, Eva; Saenz, Pilar; Lopez Ortego, Paloma; Ventura, Purificación; Galve, Zenaida; Perez Ocon, Amaya; Crespo Suarez, Pilar; Dianez Vega, Gloria; San Feliciano, Laura; Herranz Carillo, Gloria; Esteban Diez, Inés; Reyné, Mar; Garcia Borau, María José; de Las Cuevas, Isabel; Couce, María L.; González Carrasco, Ersilia; Montoro Exposito, Aurora; Concheiro Guisan, Ana; Luna Lagares, Salud; Sanchez Redondo, Maria Dolores; Hellström Westas, Lena; Moren, Stefan; Norman, Elisabeth; Olsson, Emma; Åberg, Emma; Printz, Gordana; Turner, Mark; McBride, Tim; Bomont, Robert; Webb, Delyth; Saladi, Murthy; Thirumurugan, Arumugavelu; Brooke, Nigel; Skene, Caryl; Bilolikar, Harsha; Noble, Vibert; Vora, Amish; Thompson, Fiona; Deorukhkar, Anjum; El-Refee, Sherif; McIntyre, John; Millman, Guy; Reed, Joanne; Babirecki, Matthew; Kumar, Dev; Yadav, Mahesh; O'Brien, Margaret; Gasiorowski, Edward Robert; Rawlingson, Chris; Shastri, Aravind; Tibby, Shane; Walsh, Sandra; Azzopardi, Denis; Soe, Aung; MaCrae, Duncan; Eyre, Elizabeth; Menon, Gopi; Gupta, Samir; James, Anitha; Surana, Pinki; Adams, Eleri; Wolf, Andrew; Maxwell, Nicola; Wagstaff, Miles; Mann, Rebecca; Kumar, Yadlapalli; Quinn, Michael; Jones Dyson, Steve; Mannix, Paul; Morris, Kevin; Ewer, Andrew; Gurusamy, Kalyana; Deshpande, Sanjeev; Alexander, John; Blake, Kathryn; Kumar, Siva; Oddie, Sam; Ohadike, Pamela; McKechnie, Liz; Gibson, David; Shirsalkar, Anand; Suryanarayanan, Balaji; Hubbard, Marie; Lal, Mithilesh; Ali, Imdad; Shah, Divyen; Sketchley, Suzanne; Gupta, Richa; Schofield, Joanne; Ezzat, Medhat; Mupanemunda, Richard; Gallagher, Andrew; Kronsberg, Shari

    2015-01-01

    Background Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. Methods EUROPAIN (EUROpean Pain Audit In Neonates) was a

  8. Extending labor epidural analgesia using lidocaine plus either dexmedetomidine or epinephrine for emergency cesarean section

    Directory of Open Access Journals (Sweden)

    Riham Hasanein

    2016-07-01

    Conclusion: Epidural dexmedetomidine is comparable to epinephrine as an adjuvant to epidural lidocaine in fastening the onset of surgical anesthesia and resulted in better intraoperative analgesia and in longer duration of sensory and motor block in the settings of converting labor epidural analgesia for emergency CS.

  9. Mergulho em águas rasas e lesão medular: uma abordagem educativa e preventiva = Diving in shallow waters and spinal cord injury: a preventive and educational approach

    Directory of Open Access Journals (Sweden)

    Khan, Richard Lester

    2005-01-01

    Conclusão: A lesão medular causada por mergulho em águas rasas tem uma incidência elevada no mundo principalmente no período do verão. Ocorre em indivíduos jovens, sadios, geralmente do sexo masculino apresentando uma forte associação com uso de álcool. Medidas preventivas, educativas são primordiais para a diminuição de novos casos

  10. Ovariohysterectomy requires more post-operative analgesia than orchiectomy in dogs and cats.

    Science.gov (United States)

    Quarterone, Carolina; Luna, Stelio Pacca Loureiro; Crosignani, Nadia; de Oliveira, Flávia Augusta; Lopes, Carlize; da Maia Lima, Alfredo Feio; de Araújo Aguiar, Antonio Jose

    2017-11-01

    The requirement for post-operative analgesia after ovariohysterectomy (OH) versus orchiectomy in dogs and cats was compared. Twelve male and 12 female cats and 12 male and 12 female dogs received meloxicam, 0.1 mg/kg body weight, PO, 2 h before surgery. Eleven female cats and 3 female dogs received rescue analgesia ( P = 0.002). No male of either species required rescue analgesia. The number of cats receiving rescue analgesia was greater in females than in males ( P dogs or cats. Postoperative pain after OH should be assessed for at least 2 h for cats and 4 h for dogs, using species-specific validated tools, to ensure proper postoperative pain diagnosis and management. Male dogs and cats subjected to orchiectomy required less postoperative analgesia intervention than female dogs and cats submitted to OH.

  11. Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho Bloqueo 3 en 1 prolongado versus analgesia sistemica en el tratamiento del dolor postoperatorio después de la reconstrucción del ligamento cruzado anterior de la rodilla Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Víctor A. Contreras-Domínguez

    2007-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio femoral contínuo (3-em-1 é usado para a analgesia pós-operatória de artroplastia de quadril e joelho com bons resultados, apresentando vantagens sobre outras técnicas de analgesia locorregional ou sistêmica e com baixa incidência de complicações. O objetivo deste estudo foi avaliar clinicamente a utilidade do bloqueio femoral contínuo em comparação com a analgesia por via venosa na reconstrução do ligamento cruzado anterior. MÉTODO: Foi realizado um estudo prospectivo, controlado, com 60 pacientes com estado físico ASA I. Os paciente foram divididos em dois grupos: Grupo 1 (n = 30: bloqueio femoral contínuo com infusão de bupivacaína e clonidina; Grupo 2 (n = 30: infusão por via venosa de cetoprofeno. A intervenção cirúrgica foi realizada sob raquianestesia e sedação. O tratamento da dor pós-operatória foi feito com analgesia controlada pelo paciente (PCA usando morfina. A dor pós-operatória foi registrada 2, 4, 6, 24 e 36 horas após a intervenção cirúrgica usando a Escala Visual Analógica (VAS. O consumo de morfina, a satisfação dos pacientes e as complicações também foram registradas. RESULTADOS: No Grupo 1, o VAS pós-operatório entre 4 e 48 horas após a intervenção cirúrgica foi de 21 mm ± 2 e no Grupo 2 foi de 45 mm ± 4 (p JUSTIFICATIVA Y OBJETIVOS: El bloqueo femoral continuo (tres-en-uno se usa para la analgesia postoperatoria de artroplastia de cadera y rodilla con buenos resultados, presentando ventajas sobre otras técnicas de analgesia loco regional o sistemica y con baja incidencia de complicaciones. El objetivo de este estudio fue el de evaluar clínicamente la utilidad del bloqueo femoral continuo en comparación con la analgesia intravenosa en la reconstrucción del ligamento cruzado anterior. MÉTODOS: Se realizó un estudio prospectivo controlado con 60 pacientes de estado físico ASA I. Los pacientes fueron divididos en dos grupos: Grupo 1 (n

  12. Epidural Analgesia Versus Patient-Controlled Analgesia for Pain Relief in Uterine Artery Embolization for Uterine Fibroids: A Decision Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kooij, Sanne M. van der, E-mail: s.m.vanderkooij@amc.uva.nl; Moolenaar, Lobke M.; Ankum, Willem M. [Academic Medical Centre, Department of Gynaecology (Netherlands); Reekers, Jim A. [Academic Medical Centre, Department of Radiology (Netherlands); Mol, Ben Willem J. [Academic Medical Centre, Department of Gynaecology (Netherlands); Hehenkamp, Wouter J. K. [VU University Medical Centre, Department of Gynaecology (Netherlands)

    2013-12-15

    Purpose: This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids. Methods: Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications. Results: Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were Euro-Sign 191 and Euro-Sign 355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were Euro-Sign 105 and Euro-Sign 179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA. Conclusions: The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.

  13. Hypnotic analgesia reduces brain responses to pain seen in others.

    Science.gov (United States)

    Braboszcz, Claire; Brandao-Farinelli, Edith; Vuilleumier, Patrik

    2017-08-29

    Brain responses to pain experienced by oneself or seen in other people show consistent overlap in the pain processing network, particularly anterior insula, supporting the view that pain empathy partly relies on neural processes engaged by self-nociception. However, it remains unresolved whether changes in one's own pain sensation may affect empathic responding to others' pain. Here we show that inducing analgesia through hypnosis leads to decreased responses to both self and vicarious experience of pain. Activations in the right anterior insula and amygdala were markedly reduced when participants received painful thermal stimuli following hypnotic analgesia on their own hand, but also when they viewed pictures of others' hand in pain. Functional connectivity analysis indicated that this hypnotic modulation of pain responses was associated with differential recruitment of right prefrontal regions implicated in selective attention and inhibitory control. Our results provide novel support to the view that self-nociception is involved during empathy for pain, and demonstrate the possibility to use hypnotic procedures to modulate higher-level emotional and social processes.

  14. Are Children the Better Placebo Analgesia Responders? An Experimental Approach.

    Science.gov (United States)

    Wrobel, Nathalie; Fadai, Tahmine; Sprenger, Christian; Hebebrand, Johannes; Wiech, Katja; Bingel, Ulrike

    2015-10-01

    There is little information regarding changes in placebo responsiveness with age, although first predictors of placebo responders such as psychological and physiological processes have been identified. Reviews and meta-analyses indicate that placebo response rates in randomized controlled trials (RCTs) are higher in children and adolescents compared with adults. As these studies cannot control for age-dependent differences in the natural course of the disease, biases might contribute to different placebo rates in RCTs. To avoid these biases, this study investigated age-related differences in placebo responsiveness between children and adults in a well-established experimental model of placebo analgesia combining classic conditioning and expectation. Our data confirm placebo analgesic responses in children, which did not differ in magnitude from those of adults. The influence of previous experience on subsequent treatment outcome was stronger in children than in adults, indicating an increased relevance of learning processes for treatment outcomes in children. Further studies are needed to understand the influence of treatment-related learning processes in children and adolescents, which might critically determine treatment responsiveness during adulthood. This study is the first to experimentally explore placebo analgesia and influences of previous experience on placebo responses in children compared with adults. We found comparable placebo responses in both groups and an increased relevance of learning processes for treatment outcomes in children. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  15. Specifying the non-specific components of acupuncture analgesia

    Science.gov (United States)

    Vase, Lene; Baram, Sara; Takakura, Nobuari; Yajima, Hiroyoshi; Takayama, Miho; Kaptchuk, Ted J.; Schou, Søren; Jensen, Troels Staehelin; Zachariae, Robert; Svensson, Peter

    2014-01-01

    It is well known that acupuncture has pain-relieving effects, but the contribution of specific and especially non-specific factors to acupuncture analgesia is less clear. One hundred and one patients who developed pain ≥ 3 on a visual analog scale (VAS, 0-10) following third molar surgery were randomized to receive active acupuncture, placebo acupuncture, or no treatment for 30 min with acupuncture needles with potential for double-blinding. Patients’ perception of the treatment (active or placebo), and expected pain levels (VAS) were assessed prior to and halfway through the treatment. Looking at actual treatment allocation, there was no specific effect of active acupuncture (P = 0.240), but a large and significant non-specific effect of placebo acupuncture (P acupuncture (P acupuncture had significantly lower pain levels than those who believed they received placebo acupuncture. Expected pain levels accounted for significant and progressively larger amounts of the variance in pain ratings following both active and placebo acupuncture (up to 69.8%), This is the first study to show that under optimized blinding conditions non-specific factors such as patients’ perception of and expectations toward treatment are central to the efficacy of acupuncture analgesia and that these factors may contribute to self-reinforcing effects in acupuncture treatment To obtain an effect of acupuncture in clinical practice it may, therefore, be important to incorporate and optimize these factors. PMID:23707680

  16. [Mechanisms and applications of transcutaneous electrical nerve stimulation in analgesia].

    Science.gov (United States)

    Tang, Zheng-Yu; Wang, Hui-Quan; Xia, Xiao-Lei; Tang, Yi; Peng, Wei-Wei; Hu, Li

    2017-06-25

    Transcutaneous electrical nerve stimulation (TENS), as a non-pharmacological and non-invasive analgesic therapy with low-cost, has been widely used to relieve pain in various clinical applications, by delivering current pulses to the skin area to activate the peripheral nerve fibers. Nevertheless, analgesia induced by TENS varied in the clinical practice, which could be caused by the fact that TENS with different stimulus parameters has different biological mechanisms in relieving pain. Therefore, to advance our understanding of TENS in various basic and clinical studies, we discussed (1) neurophysiological and biochemical mechanisms of TENS-induced analgesia; (2) relevant factors that may influence analgesic effects of TENS from the perspectives of stimulus parameters, including stimulated position, pulse parameters (current intensity, frequency, and pulse width), stimulus duration and used times in each day; and (3) applications of TENS in relieving clinical pain, including post-operative pain, chronic low back pain and labor pain. Finally, we propose that TENS may involve multiple and complex psychological neurophysiological mechanisms, and suggest that different analgesic effects of TENS with different stimulus parameters should be taken into consideration in clinical applications. In addition, to optimize analgesic effect, we recommend that individual-based TENS stimulation parameters should be designed by considering individual differences among patients, e.g., adaptively adjusting the stimulation parameters based on the dynamic ratings of patients' pain.

  17. Pharmacological therapy for analgesia and sedation in the newborn.

    Science.gov (United States)

    Anand, K J S; Hall, R W

    2006-11-01

    Rapid advances have been made in the use of pharmacological analgesia and sedation for newborns requiring neonatal intensive care. Practical considerations for the use of systemic analgesics (opioids, non-steroidal anti-inflammatory agents, other drugs), local and topical anaesthetics, and sedative or anaesthetic agents (benzodiazepines, barbiturates, other drugs) are summarised using an evidence-based medicine approach, while avoiding mention of the underlying basic physiology or pharmacology. These developments have inspired more humane approaches to neonatal intensive care. Despite these advances, little is known about the clinical effectiveness, immediate toxicity, effects on special patient populations, or long-term effects after neonatal exposure to analgesics or sedatives. The desired or adverse effects of drug combinations, interactions with non-pharmacological interventions or use for specific conditions also remain unknown. Despite the huge gaps in our knowledge, preliminary evidence for the use of neonatal analgesia and sedation is available, but must be combined with a clear definition of clinical goals, continuous physiological monitoring, evaluation of side effects or tolerance, and consideration of long-term clinical outcomes.

  18. [Benefits of epidural analgesia in major neonatal surgery].

    Science.gov (United States)

    Gómez-Chacón, J; Encarnación, J; Couselo, M; Mangas, L; Domenech, A; Gutiérrez, C; García Sala, C

    2012-07-01

    The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.

  19. Acupuncture analgesia: The complementary pain management in dentistry

    Directory of Open Access Journals (Sweden)

    Abdurachman Abdurachman

    2011-03-01

    Full Text Available Background: Pain is the most common reason for medical consultation in the United States. Pain is a major symptom in many medical conditions, and can significantly interfere with a person’s quality of life and general functioning. One of the very unpleasant pain is toothache. Conventional treatments for toothache are improving oral hygiene, prescribing analgesics, anti-inflammatory, and also antibiotics if there are infection even extractions are performed if necessary. Another way to conventional approaches, patients may consider acupuncture method. Acupuncture involves the insertion of needles with the width of a human hair along the precise points throughout the body. This process triggers body’s energy normal flow through extra anatomy pathway called meridian. Purpose: This case report is aimed to emphasize the existence of teeth-organ relationships through communication channels outside the lines of communication that has been known in anatomy. Case: Two patients with toothache complaints in the lower right molars came to an acupuncturist who was a medical practitioner. In these cases pain were relieved by acupuncture analgesia. Case management: Two patients were subjected to acupuncture analgesia with different acupuncture points that were customized to the affected tooth, case 1 with the large intestine-4 (Li-4 which located in the hand and case 2 with bladder-25 (Bl-25 which located in the back of the body. Ninety percent of pain was relieved in 40 seconds. Conclusion: Pain in toothache can be relieved using acupuncture analgesia technique, using meridian as an extra anatomy pathway. Nevertheless, treating the source of pain by dental practitioner is mandatory.Latar belakang: Nyeri adalah alasan paling umum yang menyebabkan orang datang berkonsultasi kepada profesional medis di Amerika Serikat. Nyeri merupakan gejala utama dalam kasus medis, dan dapat mengganggu kualitas hidup dan kegiatan umum seseorang secara signifikan. Salah satu

  20. Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA

    Science.gov (United States)

    Hernández-Hernández, Alberto L.; Perez-Jimenez, David

    2012-01-01

    Compendio El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes. PMID:23264700

  1. Functional network architecture predicts psychologically mediated analgesia related to treatment in chronic knee pain patients.

    Science.gov (United States)

    Hashmi, Javeria Ali; Kong, Jian; Spaeth, Rosa; Khan, Sheraz; Kaptchuk, Ted J; Gollub, Randy L

    2014-03-12

    Placebo analgesia is an indicator of how efficiently the brain translates psychological signals conveyed by a treatment procedure into pain relief. It has been demonstrated that functional connectivity between distributed brain regions predicts placebo analgesia in chronic back pain patients. Greater network efficiency in baseline brain networks may allow better information transfer and facilitate adaptive physiological responses to psychological aspects of treatment. Here, we theorized that topological network alignments in resting state scans predict psychologically conditioned analgesic responses to acupuncture treatment in chronic knee osteoarthritis pain patients (n = 45). Analgesia was induced by building positive expectations toward acupuncture treatment with verbal suggestion and heat pain conditioning on a test site of the arm. This procedure induced significantly more analgesia after sham or real acupuncture on the test site than in a control site. The psychologically conditioned analgesia was invariant to sham versus real treatment. Efficiency of information transfer within local networks calculated with graph-theoretic measures (local efficiency and clustering coefficients) significantly predicted conditioned analgesia. Clustering coefficients in regions associated with memory, motivation, and pain modulation were closely involved in predicting analgesia. Moreover, women showed higher clustering coefficients and marginally greater pain reduction than men. Overall, analgesic response to placebo cues can be predicted from a priori resting state data by observing local network topology. Such low-cost synchronizations may represent preparatory resources that facilitate subsequent performance of brain circuits in responding to adaptive environmental cues. This suggests a potential utility of network measures in predicting placebo response for clinical use.

  2. Gender-specific and gonadectomy-specific effects upon swim analgesia: role of steroid replacement therapy.

    Science.gov (United States)

    Romero, M T; Cooper, M L; Komisaruk, B R; Bodnar, R J

    1988-01-01

    Both gender-specific and gonadectomy-specific effects have been observed for the analgesic responses following continuous and intermittent cold-water swims (CCWS and ICWS respectively): female rats display significantly less analgesia than males, and gonadectomized rats display significantly less analgesia than sham-operated controls. The present study evaluated the effects of steroid replacement therapy with testosterone propionate (TP: 2 mg/kg, SC) upon CCWS and ICWS analgesia on the tail-flick and jump tests and hypothermia in sham-operated or gonadectomized male and female rats. Thirty days following surgery, rats received either no treatment, a sesame oil vehicle or TP for 14 days prior to, and then during testing. Relative to the no treatment condition, repeated vehicle injections in sham-operated rats eliminated the gender-specific, but did not affect the gonadectomy-specific effects upon CCWS and ICWS analgesia. TP reversed the deficits in CCWS and ICWS analgesia observed in both castrated and ovariectomized rats on both pain tests. TP only potentiated CCWS analgesia in sham-operated males on the tail-flick test. TP potentiated CCWS and ICWS hypothermia in gonadectomized rats and in male sham-operated rats. These data indicate that gonadal steroids play a major modulatory role in the etiology of swim analgesia, and that the observed gender effects are sensitive to possible adaptational variables.

  3. Naltrexone-sensitive analgesia following exposure of mice to 2450-MHz radiofrequency radiation (RFR)

    Energy Technology Data Exchange (ETDEWEB)

    Maillefer, R.H.; Quock, R.M. (Univ. of Illinois, Rockford (United States))

    1991-03-11

    This study was conducted to determine whether exposure to RFR might induce sufficient thermal stress to activate endogenous opioid mechanisms and induce analgesia. Male Swiss Webster mice, 20-25 g, were exposed to 10, 15 or 20 mV/cm{sup 2} RFR in a 2,450-MHz waveguide system for 10 min, then tested in the abdominal constriction paradigm. Specific absorption rates (SAR) were 23.7 W/kg at 10 mW/cm{sup 2}, 34.6 W/kg at 15 mW/cm{sup 2} and 45.5 W/kg at 20 mW/cm{sup 2}. Confinement in the exposure chamber alone did not appreciably alter body temperature but did appear to induce a stress-associated analgesia that was insensitive to the opioid receptor blocker naltrexone. Exposure of confined mice to RFR elevated body temperature and further increased analgesia in SAR-dependent manner. The high-SAR RFR-induced analgesia, but not the hyperthermia, was reduced by naltrexone. These findings suggest that (1) RFR produces SAR-dependent hyperthermia and analgesia and (2) RFR-induced analgesia is mediated by opioid mechanisms while confinement-induced analgesia involves non-opioid mechanisms.

  4. Subcutaneous L-tyrosine elicits cutaneous analgesia in response to local skin pinprick in rats.

    Science.gov (United States)

    Hung, Ching-Hsia; Chiu, Chong-Chi; Liu, Kuo-Sheng; Chen, Yu-Wen; Wang, Jhi-Joung

    2015-10-15

    The purpose of the study was to estimate the ability of L-tyrosine to induce cutaneous analgesia and to investigate the interaction between L-tyrosine and the local anesthetic lidocaine. After subcutaneously injecting the rats with L-tyrosine and lidocaine in a dose-dependent manner, cutaneous analgesia (by blocking the cutaneous trunci muscle reflex-CTMR) was evaluated in response to the local pinprick. The drug-drug interaction was analyzed by using an isobolographic method. We showed that both L-tyrosine and lidocaine produced dose-dependent cutaneous analgesia. On the 50% effective dose (ED50) basis, the rank of drug potency was lidocaine (5.09 [4.88-5.38] μmol)>L-tyrosine (39.1 [36.5-41.8] μmol) (Ptyrosine lasted longer than that caused by lidocaine (Ptyrosine exhibited an additive effect on infiltrative cutaneous analgesia. Our pre-clinical study demonstrated that L-tyrosine elicits the local/cutaneous analgesia, and the interaction between L-tyrosine and lidocaine is additive. L-tyrosine has a lower potency but much greater duration of cutaneous analgesia than lidocaine. Adding L-tyrosine to lidocaine preparations showed greater duration of cutaneous analgesia compared with lidocaine alone. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

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    Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen; Bergholt, Thomas; Skjeldestad, Finn E

    2018-03-07

    Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.

    Science.gov (United States)

    Ross, Emma L; Reiter, Pamela D; Murphy, Michael E; Bielsky, Alan R

    2015-09-01

    To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours. A retrospective cohort review of the electronic medical record over a 14-month period. The level IV neonatal intensive care unit of a 414-bed free-standing children's hospital. Eighteen infants (mean age, 1.7 ± 1.8 months [0.03-6.3]; mean weight, 3.8 ± 1.3 kg [1.56-6.9]; n = 10 [55%] males) received 1% chloroprocaine for epidural analgesia postoperatively for up to 96-hour duration and met criteria for inclusion. Dosing requirements, placement of epidural catheter, supplementary analgesic therapy, respiratory support, vital signs, and incidence of adverse events associated with local anesthetics were collected. Epidural catheter placement was caudal (n = 8), lumbar (n = 6), or thoracic (n = 4). Mean operative time was 2.48 ± 1 hour (1-5). Initial chloroprocaine dose was 1.3 ± 0.5 mL/h (0.4-2.5) (3.5 ± 1 mg/kg per hour [1.4-5]) with a maximum dose of 1.5 ± 0.6 mL/h (0.4-3) (4.2 ± 1.1 mg/kg per hour [2.2-6.1]). Duration of epidural analgesia was 48.3 ± 21.5 hours (10-96). Duration of epidural infusion did not influence dosing requirement, suggesting the absence of drug tachyphylaxis. All patients received intermittent doses of opioid and nonopioid pain medications while receiving chloroprocaine. Two mechanically ventilated patients required continuous infusion of opioids. No adverse events were directly attributed to chloroprocaine use. Epidural 1% chloroprocaine, in doses of 0.4-3 mL/h (1.5-6.1 mg/kg per hour), was well tolerated in both mechanically ventilated and spontaneously breathing infants for up to 96 hours with no identified adverse effects or tachyphylaxis. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

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    Torvaldsen Siranda

    2010-04-01

    Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

  8. Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments.

    Science.gov (United States)

    Poonai, Naveen; Cowie, Allyson; Davidson, Chloe; Benidir, Andréanne; Thompson, Graham C; Boisclair, Philippe; Harman, Stuart; Miller, Michael; Butter, Andreana; Lim, Rod; Ali, Samina

    2016-09-01

    Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts.

  9. Gravity of injury and analgesia in patients who suffered traffic accidents Gravedad de la lesión y analgesia en pacientes que sufrieron accidentes de tránsito Gravidade da lesão e analgesia em pacientes que sofreram acidentes de transporte

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    Ana Maria Calil

    2008-01-01

    Full Text Available OBJECTIVE: Identifying the frequency and gravity of injuries in patients who suffered accidents in traffic and the analgesic drugs utilized. METHODS: Retrospective study, with a sample of 200 medical records of patients admitted to the emergency services of a reference hospital for trauma care. The gravity of the injuries was characterized by anatomic gravity rates and the analgesic therapy was based on the World Health Organization's Analgesic Ladder. RESULTS: The main findings pointed to injuries in limbs, head, face and outer surface as the most frequent, and, in 85% of the cases, gravity was equal or lower than 3; As for analgesia, it was verified that 46;6% of the patients received dipyrone and paracetamol. Among the opioids, meperidine was used in 10.4% of the cases. CONCLUSION: The gravity of most injuries was equal or lower to 3, indicating injuries of light, moderate and serious gravity, located especially in four body regions; regarding analgesia, dipyrone was shown to be the most commonly-used drug and a low use of opioids was verified.OBJETIVOS: Identificar la frecuencia y gravedad de las lesiones en accidentados de tránsito y las drogas analgésicas utilizadas. MÉTODOS: Se trata de un estudio retrospectivo, con muestra de 200 historias clínicas de pacientes internados en el servicio de emergencia de un Hospital de referencia para la atención al trauma. La gravedad de las lesiones fue caracterizada por índices de gravedad anatómicos y la terapéutica analgésica con base en la Escalera Analgésica de la Organización Mundial de la Salud. RESULTADOS: Los principales hallazgos apuntaron las lesiones en miembros, cabeza, cara y superficie externa como las más frecuentes, y en un 85% de los casos con gravedad menor o igual a 3; en cuanto a la analgesia se verificó que el 46,6% de los pacientes recibieron dipirona y paracetamol, entre los opioides se destacó la meperidina con el 10,4%. CONCLUSIÓN: La mayoría de las lesiones

  10. Morphine- and buprenorphine-induced analgesia and antihyperalgesia in a human inflammatory pain model

    DEFF Research Database (Denmark)

    Ravn, Pernille; Secher, EL; Skram, U

    2013-01-01

    Opioid therapy is associated with the development of tolerance and paradoxically increased sensitivity to pain. It has been suggested that buprenorphine is associated with a higher antihyperalgesia/analgesia ratio than μ-opioid receptor agonists. The primary outcome of this study was therefore...... to investigate relative differences in antihyperalgesia and analgesia effects between morphine and buprenorphine in an inflammatory pain model in volunteers. The secondary outcome was to examine the relationship between pain sensitivity and opioid-induced effects on analgesia, antihyperalgesia, and descending...... pain modulation....

  11. Neuraxial analgesia effects on labor progression: facts, fallacies, uncertainties, and the future

    Science.gov (United States)

    Grant, Erica N.; Tao, Weike; Craig, Margaret; McIntire, Donald; Leveno, Kenneth

    2014-01-01

    Approximately 60% of women who labor receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labor and delivery process. In this review, we attempt to clarify what has been established as truths, falsities, and uncertainties regarding the effects of this form of pain relief on labor progression, negative and/or positive. Additionally, although the term “epidural” has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labor progression. PMID:25088476

  12. Intravenous sub-anesthetic ketamine for perioperative analgesia

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    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  13. Paraplegia following epidural analgesia: A potentially avoidable cause?

    Directory of Open Access Journals (Sweden)

    Jeson R Doctor

    2014-01-01

    Full Text Available Neurological deficit is an uncommon but catastrophic complication of epidural anesthesia. Epidural hematomas and abscesses are the most common causes of such neurological deficit. We report the case of a patient with renal cell carcinoma with lumbar vertebral metastasis who developed paraplegia after receiving thoracic epidural anesthesia for a nephrectomy. Subsequently, on histo-pathological examination of the laminectomy specimen, the patient was found to have previously undiagnosed thoracic vertebral metastases which led to a thoracic epidural hematoma. In addition, delayed reporting of symptoms of neurological deficit by the patient may have impacted his outcome. Careful pre-operative investigation, consideration to using alternative modalities of analgesia, detailed patient counseling and stringent monitoring of patients receiving central neuraxial blockade is essential to prevent such complications.

  14. High-volume infiltration analgesia in bilateral hip arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

    2011-01-01

    bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...... (range 2-7) days. Interpretation Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib...

  15. Epidural analgesia in patients with traumatic rib fractures

    DEFF Research Database (Denmark)

    Duch, P; Møller, M H

    2015-01-01

    BACKGROUND: Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials...... (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration...

  16. Current status of patient-controlled analgesia in cancer patients.

    Science.gov (United States)

    Ripamonti, C; Bruera, E

    1997-03-01

    Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. Parameters, such as route, drug concentration dose, frequency, and maximum daily or hourly dose, are programmed by the physician. The patient decides whether or not to take a dose. Devices can be used to deliver the drug into a running intravenous infusion, the epidural space, or subcutaneously. Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.

  17. Analgesia and sedation practices for incarcerated inguinal hernias in children.

    Science.gov (United States)

    Al-Ansari, Khalid; Sulowski, Christopher; Ratnapalan, Savithiri

    2008-10-01

    In this study, the use of medications for analgesia and/or sedation for incarcerated inguinal hernia reductions in the emergency department was analyzed. A retrospective chart review was conducted for all patients presenting to a pediatric emergency department with incarcerated inguinal hernia from 2002 to 2005. A total of 99 children presented with incarcerated hernias during the study period. The median age was 11 months. Forty-four percent of children received medication for the procedure, of them 75% received parenteral and 25% oral or intranasal medications. Forty-five percent of children who received medication went through at least 1 hernia reduction attempt initially without medications. More than half the children with incarcerated inguinal hernias did not receive any medication for pain and/or sedation prior to hernia reduction. Guidelines for medication use for children with incarcerated inguinal hernias need to be developed.

  18. Polyglycerol-opioid conjugate produces analgesia devoid of side effects.

    Science.gov (United States)

    González-Rodríguez, Sara; Quadir, Mohiuddin A; Gupta, Shilpi; Walker, Karolina A; Zhang, Xuejiao; Spahn, Viola; Labuz, Dominika; Rodriguez-Gaztelumendi, Antonio; Schmelz, Martin; Joseph, Jan; Parr, Maria K; Machelska, Halina; Haag, Rainer; Stein, Christoph

    2017-07-04

    Novel painkillers are urgently needed. The activation of opioid receptors in peripheral inflamed tissue can reduce pain without central adverse effects such as sedation, apnoea, or addiction. Here, we use an unprecedented strategy and report the synthesis and analgesic efficacy of the standard opioid morphine covalently attached to hyperbranched polyglycerol (PG-M) by a cleavable linker. With its high-molecular weight and hydrophilicity, this conjugate is designed to selectively release morphine in injured tissue and to prevent blood-brain barrier permeation. In contrast to conventional morphine, intravenous PG-M exclusively activated peripheral opioid receptors to produce analgesia in inflamed rat paws without major side effects such as sedation or constipation. Concentrations of morphine in the brain, blood, paw tissue, and in vitro confirmed the selective release of morphine in the inflamed milieu. Thus, PG-M may serve as prototype of a peripherally restricted opioid formulation designed to forego central and intestinal side effects.

  19. Imaging-guided hyperstimulation analgesia in low back pain

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    Gorenberg M

    2013-06-01

    Full Text Available Miguel Gorenberg,1,2 Kobi Schwartz31Department of Nuclear Medicine, B'nai Zion Medical Center, Haifa, Israel; 2The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; 3Department of Physical Therapy, B'nai Zion Medical Center, Haifa, IsraelAbstract: Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.Keywords: myofascial, noninvasive, electrical, impedance

  20. Clonidine for sedation and analgesia for neonates receiving mechanical ventilation.

    Science.gov (United States)

    Romantsik, Olga; Calevo, Maria Grazia; Norman, Elisabeth; Bruschettini, Matteo

    2017-05-10

    Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates. To compare the intervention versus placebo, no treatment, and dexmedetomidine; and to assess the safety of clonidine infusion for potential harms.To perform subgroup analyses according to gestational age; birth weight; administration method (infusion or bolus therapy); dose, duration, and route of clonidine administration; and pharmacologic sedation as a co-intervention. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library, MEDLINE via PubMed (1966 to January 10, 2017), Embase (1980 to January 10, 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 10, 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. We searched for randomized controlled trials, quasi-randomized controlled trials, and cluster trials comparing clonidine versus placebo, no treatment, or dexmedetomidine administered to term and preterm newborns receiving mechanical ventilation via an endotracheal tube. For the included trial, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, all-cause death during initial hospitalization, duration of respiratory support, sedation

  1. [Analgesia and sedation in neonatal-pediatric intensive care].

    Science.gov (United States)

    Schlünder, C; Houben, F; Hartwig, S; Theisohn, M; Roth, B

    1991-01-01

    In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. In newborn and premature infants, fentanyl alone has been sufficient because of its analgesic and sedative action. In a study on 20 newborns and prematures suffering from severe respiratory problems as compared with a historical group that did not receive fentanyl, we could show that in subjects receiving fentanyl, considerably less treatment with sedatives and other analgesics was necessary. Cardiopulmonary tolerance was satisfactory. The highest bilirubin values were reached about 1 day earlier and were slightly higher than those measured in the control group, but oral nutrition could be initiated sooner. In small infants, additional midazolam was given after cardiac surgery. During the first 72 h, we found a correlation between serum levels of midazolam and the depth of sedation; however, after 72 h of medication, the dose had to be raised because of an increase in metabolic clearance. During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.

  2. Randomized comparison of effectiveness of unimodal opioid analgesia with multimodal analgesia in post–cesarean section pain management

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    Adeniji AO

    2013-05-01

    Full Text Available Adetunji Oladeni Adeniji,1 Oluseyi Olaboyede A Atanda21Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria; 2Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, NigeriaBackground: Postoperative pain leads to patient discomfort, decreased level of satisfaction, prolonged recovery, and higher health costs. Acute pain control therefore improves the overall quality of life in patients undergoing cesarean section. Pain relief is a fundamental human right, but there is no gold standard for post–cesarean section pain management.Objective: To compare the efficacy of pentazocine and tramadol used in unimodal and multimodal (in combination with piroxicam approach, in the management of post–cesarean section pain.Materials and methods: This study employed a random allocation design to compare the effectiveness of intramuscular pentazocine (60 mg or tramadol (100 mg as single analgesic agent and in combination with daily intramuscular piroxicam 20 mg, for the management of post–cesarean section pain during the immediate 12 hours after surgery. The primary outcome measure was control of postoperative pain, while the secondary outcome measures were the analgesic agent onset of action, duration of action, patient satisfaction, and maternal and neonatal adverse outcomes. Data obtained were entered into a predesigned sheet and analyzed with the Statistical Package for Social Sciences version 17. Means ± standard deviation (SD were calculated for the quantitative variables, and the difference between two independent groups was compared using unpaired Student's t-test. The level of significance was set at 0.05.Results: A total of 120 patients were equally and randomly allocated to four study groups – two that received unimodal analgesia (the pentazocine group and the tramadol group and two that received multimodal analgesia (the pentazocine

  3. Comparison of ropivacaine (0.2%) with or without clonidine 1 μg/kg for epidural labor analgesia: A randomized controlled study

    OpenAIRE

    Indira Kumari; Kapil Sharma; Vikram Bedi; Madhan Mohan; Hemraj Tungaria; Manish Kumar Modi

    2018-01-01

    Background and Aims: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. Material and Methods: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups. Group ...

  4. Paciente con esquizofrenia tratado con ziprasidona + clozapina

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    Pol Yanguas E.

    2013-05-01

    Full Text Available P es un paciente diagnosticado de esquizofrenia, sigue en un piso tutelado un programa de rehabilitación, está medicado con clozapina 500 mg/día y ziprasidona 280 mg/ día. Padece hipercolesterolemia, tabaquismo y sus hábitos alimenticios no son buenos. La medicación que utiliza desde 2007 hasta ahora se refleja en la tabla 1. El último tratamiento se le introdujo el 7 de agosto de 2012, habiendo presentado un electro cardiograma (ECG normal, pero con ligera taquicardia ventricular y prolactinemia de 44,8 ng/ml (valores normales: 2-18 ng/ml.

  5. Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

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    Patrícia Gomes da Silva

    2011-12-01

    Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

  6. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Não obstante o bloqueio pleural ter sido convertido quase numa panacéia analgésica, resultados contraditórios foram publicados. O objetivo deste estudo foi observar o desempenho analgésico e espirométrico das funções pulmonares no pós-operatório imediato de 21 pacientes com o bloqueio pleural bilateral em laparotomias medianas de urgência. MÉTODO: Bloqueio pleural bilateral foi realizado em decúbito dorsal horizontal em 21 pacientes com 20 ml de bupivacaína a 0,375% com adrenalina a 1:400.000 administrados por cateter em cada hemitórax durante o pós-operatório imediato. Soluções aleatórias de bupivacaína e de solução fisiológica foram administradas por residentes ou enfermeiras que desconheciam o conteúdo das seringas, e seus desfechos analgésicos avaliados de acordo com a escala de dor Prince Henry ao comparar os valores pré e pós-bloqueio pleural bilateral. Em função da dor pós-operatória, testes espirométricos das funções pulmonares também foram determinados mediante espirômetro portátil. RESULTADOS: Analgesia pós-operatória, com duração média de 247,75 ± 75 minutos foi constatada em todos os pacientes com a bupivacaína, embora tenha persistido dor residual de menor intensidade na região suprapúbica em cinco pacientes (8% e em dois pacientes na apófise xifóide (3,2%. Nenhum efeito analgésico foi obtido com solução fisiológica. Face à dor pós-operatória, as funções pulmonares, avaliadas antes e após os bloqueios, registraram melhora com a bupivacaína na CVF (p JUSTIFICATIVA Y OBJETIVOS: No obstante el bloqueo pleural haber sido convertido casi en una panacea analgésica, fueron publicados resultados contradictorios. El objetivo de este estudio fue observar el desempeño analgésico y espirométrico de las funciones pulmonares en el pós-operatorio inmediato de 21 pacientes con el bloqueo pleural bilateral en laparotomias medianas de urgencia. M

  7. Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas Telephone versus face-to-face household interviews in the assessment of health behaviors and preventive practices

    Directory of Open Access Journals (Sweden)

    Iñaki Galán

    2004-12-01

    Full Text Available Objetivo: En este estudio se examina la influencia del método de encuesta, telefónica y «cara a cara» domiciliaria, sobre la estimación de los factores de riesgo para la salud asociados al comportamiento y la realización de prácticas preventivas. Material y método: El mismo cuestionario fue administrado en 2 muestras independientes de población de 18-64 años residente en el municipio de Madrid. Una muestra (n = 1.391 realizó la entrevista telefónica y la otra (n = 739, la entrevista «cara a cara» domiciliaria. Se compararon los resultados de las 2 muestras para 28 variables relacionadas con la antropometría, la actividad física, el consumo de alimentos, el consumo de tabaco y alcohol, las prácticas preventivas y la accidentabilidad. Resultados: La muestra telefónica obtuvo una mayor tasa de no contactos (31,8 frente a 22,2% pero un mayor grado de cooperación que la muestra con entrevista «cara a cara» (83 frente a 74%. En total, 19 de las 28 variables mostraron una variación relativa entre ambas encuestas Objective: This study examines the influence of the interview method (telephone or face-to-face in households on the assessment of health behaviors and preventive practices. Material and method: The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects completed the questionnaire by telephone interview and the other (n = 739 by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared. Results: The telephone sample had a higher rate of failed contact (31.8% vs. 22.2% but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%. In total, 19 of the 28 variables showed a relative variation of less than 10% between the

  8. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

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    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  9. Labor induction just after external cephalic version with epidural analgesia at term.

    Science.gov (United States)

    Cuerva, Marcos J; Piñel, Carlos S; Caceres, Javier; Espinosa, Jose A

    2017-06-01

    To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient. Copyright © 2017. Published by Elsevier B.V.

  10. Labor induction just after external cephalic version with epidural analgesia at term

    Directory of Open Access Journals (Sweden)

    Marcos J. Cuerva

    2017-06-01

    Conclusion: Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient.

  11. Safety of retransfusing shed blood after local infiltration analgesia in total knee arthroplasty

    NARCIS (Netherlands)

    Thomassen, B.J.; Pool, L.; Van Der Flier, R.; Stienstra, R.; in 't Veld, B.A.

    2012-01-01

    We investigated the safety of LIA (local infiltration analgesia) combined with retransfusion of drained blood. Total knee arthroplasty patients received two peri-articular injections during surgery followed by continuous infusion, both with ropivacaine (567 mg). Ropivacaine plasma concentrations

  12. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

  13. Labor analgesia in parturients of fetal growth restriction having raised umbilical Doppler vascular indices

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    Sukhen Samanta

    2018-01-01

    Conclusions: Continuous epidural ropivacaine causes improved fetoplacental circulation in parturients with growth-restricted fetuses having raised Doppler indices during labor analgesia. We also found better neonatal outcome with continuous infusion of epidural ropivacaine as compared to IM tramadol.

  14. [Eutopic parturition: psychoprophylaxis or extradural analgesia. Influence on the endocrine response].

    Science.gov (United States)

    Carrasco, M S; Iglesias, J; Freire, J; Martín, M L; Marín Santana, A; Cobo, I; García Rendón, A

    1989-01-01

    Prolactin, ACTH, cortisol and HGH levels have been studied on 30 pregnant women in three different periods: during the labour, at the delivery and 24 hours later. They were divided into 3 groups depending on the analgesia: I) no analgesia (n = 10); II) psychoprophylaxis (n = 10), and III) extradural analgesia (n = 10). Prolactin levels increased during delivery and 24 hours later. A significant increase of ACTH levels (p less than 0.01) was observed during the delivery in the 3 groups even though they were under hasal values 24 hours later. Cortisol increased 38% (p less than 0.01) and 52% (p less than 0.02) in II and III groups, respectively during the delivery. No difference was found with HGH. Our results suggest that endocrine response modified by labour and delivery doesn't change with different analgesia techniques.

  15. Hacia una nueva medicina preventiva

    OpenAIRE

    Lizaraso Caparó, Frank; Facultad de Medicina Humana de la Universidad de San Martín de Porres; Ruiz Mori, Enrique; Facultad de Medicina Humana de la Universidad de San Martín de Porres

    2016-01-01

    En la actualidad las enfermedades que captan la mayor atención pública son las enfermedades infecciosas como el VIH/SIDA, la tuberculosis, la malaria o el dengue; sin embargo según el informe de la Organización Mundial de la Salud (OMS) son las Enfermedades Crónicas No Transmisibles (ECNT) la principal causa de muerte a nivel mundial, ocasionando alrededor de 36 de los 57 millones de fallecidos por enfermedades cardiovasculares, cáncer, enfermedad pulmonar crónica y diabetes (1). Y la alerta ...

  16. Utilidad preventiva del constructo "trastorno mental grave" en el ámbito sociosanitario Preventive usefulness of the concept "serious mental disorder" in social-sanitary area

    Directory of Open Access Journals (Sweden)

    José Carlos Mingote Adán

    2010-12-01

    Full Text Available Introducción: El constructo "trastorno mental grave" (TMG puede ser muy útil en la práctica clínica y no sólo en el ámbito de la gestión de los recursos, al permitir diseñar intervenciones preventivas, diagnósticas y terapéuticas efectivas, especialmente en el sector servicios y en profesiones de alta fiabilidad y seguridad (sanidad, defensa, transporte, etc. en las que los errores suelen tener consecuencias directas adversas para la vida de las personas y los que se debe garantizar la máxima calidad y la seguridad de los usuarios. Objetivos: Revisar los principales aspectos a considerar en la elaboración de protocolos de intervención laboral ante trastornos mentales graves. Método: Revisión de la bibliografía disponible. Conclusiones: Se proponen herramientas y procedimientos de utilidad para afrontar los casos clínicos graves en el ámbito laboral sanitario, mejorar la calidad asistencial y contribuir a garantizar la seguridad de los usuarios y de los sanitarios enfermos.Introduction: The concept of "serious mental disorder" (SMD can be very useful in clinical medical practice, not only in the management resources area, allowing to design preventive, diagnostic and therapeutic effective interventions, but also in service area and in high reliability and security professions, such as health, defence, transport and so on. In these cases mistakes use to have direct and adverse consequences for people's life that is way a maximum quality and safety must be guaranteed for the users. Objective: To check the principal aspects to consider in the production of intervention protocols for mental serious disorders in the workplace. Method: Review of the available bibliography. Conclusions: This article proposes tools and procedures to deal with serious clinical cases in health professional field in order to improve the attendance quality, contributing to the safety of the health workers and users.

  17. ANAESTHESIA, POSTOPERATIVE ANALGESIA AND EARLY REHABILITATION FOR UPPER EXTREMITY BONE AND MAJOR JOINTS SURGERY

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    A. V. Kurnosov

    2011-01-01

    Full Text Available A new method was developed to perform prolonged brachial plexus block with almost 100% effectiveness. It was also shown in 44 patients to be 33 % safer for local complications and 11,3 % safer for general complications than common used supraclavicular Winnie block (42 patients in control group, received opiates and NSAID for post-operative analgesia. This new method of analgesia allows effective rehabilitation after elbow arthroplasty to be started on the first day after the surgery.

  18. Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status

    Directory of Open Access Journals (Sweden)

    Narmada P Gupta

    2008-01-01

    Conclusion: The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.

  19. Regional analgesia for video-assisted thoracic surgery – a systematic review

    DEFF Research Database (Denmark)

    Julia Steinthorsdottir, Kristin; Wildgaard, Lorna; Jessen Hansen, Henrik

    2013-01-01

    there is no gold standard for regional analgesia for VATS. This systematic review aimed to assess different regional techniques in regards to effect on acute post-operative pain following VATS, with emphasis on VATS lobectomy. The systematic review of the PubMed, Cochrane Library and Embase databases yielded...... be demonstrated, but a guide of factors to include in future studies on regional analgesia for VATS is presented....

  20. Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study.

    Science.gov (United States)

    Iyer, Sadasivan Shankar; Bavishi, Harshit; Mohan, Chadalavada Venkataram; Kaur, Navdeep

    2017-01-01

    Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8 th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8 th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded. Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest ( P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h ( P = 0.001). For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption.

  1. Protocolo de actuación preventiva para riesgo debido a alteraciones del ritmo circadiano en médicos de urgencias que trabajan en turnos de 24 horas Preventive action protocol for risk due to circadian rhythm disturbances in emergency physicians working in 24 hours shifts

    Directory of Open Access Journals (Sweden)

    Loreto Fillat de Acosta

    2009-12-01

    Full Text Available La autora analiza la situación patológica de los médicos de urgencias con turnos de 24 horas que alteran el ritmo circadiano, el estudio describe las condiciones de trabajo que afectan el ritmo biológico sueño-vigilia y las tareas intelectuales y de habilidades mecánicas desempeñadas por este personal, los daños a prevenir (accidentes in itinere, accidentes por manipulación de material biológico, enfermedades somáticas y psíquicas y el riesgo para los pacientes. Se propone un protocolo de actuación preventiva que abarca la mayor parte del trabajo, cuándo actuar, revisión de recursos, actuaciones a realizar en una unidad de salud laboral y sistema de comunicación al resto del hospital, Servicio de Prevención de Riesgos Laborales y Sistema Nacional de Salud.The author analyzes the pathological situation concerning to emergency physicians with 24-hour shifts which disturb their circadian rhythms, the study describes the working conditions that affect the biological sleep-wake rhythm and intellectual tasks and mechanical skills performed by these staff, damage to be prevented (commuting accidents, accidents caused by handling of biological material, somatic and psychic diseases and the risk to patients. After that, it's developed a proposal of preventive action protocol covering most of the work and finally when to act, available resources and actions to be taken in an occupational health unit, in addition to the communication system to the rest of the hospital, Occupational and Hazard Preventive Service and the National Health System.

  2. Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.

    Science.gov (United States)

    Bucklin, Brenda A; Chestnut, David H; Hawkins, Joy L

    2002-01-01

    Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. Relevant clinical studies were identified using electronic and manual searches of the literature covering the period from 1989 to 2000. Searches used the following descriptors: intrathecal analgesia, spinal opioids, epidural analgesia, epidural local anesthetics, and analgesia for labor. Data were extracted from 7 randomized clinical trials comparing analgesic measures, incidence of motor block, pruritus, nausea, hypotension, mode of delivery, and/or Apgar scores. Combined test results indicated comparable analgesic efficacy 15 to 20 minutes after injection with single-injection intrathecal opioid administration. Intrathecal opioid injections were associated with a greater incidence of pruritus (odds ratio, 14.01; 99% confidence interval, 6.9 to 28.3), but there was no difference in the incidence of nausea or in the method of delivery. Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.

  3. Optimization of postoperative analgesia after adenoidectomy in children

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    M. A. Georgiyants

    2017-04-01

    Full Text Available It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41 those who received propofol in combination with fentanyl; group II (n = 40 those who received sevoflurane in combination with fentanyl; group III (n = 36 those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces» and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain

  4. Diferencias en tiempos de incapacidad según el tipo de manejo (convencional o temprano), en pacientes con dolor lumbar agudo secundario a accidentes de trabajo en una aseguradora de riesgos profesionales (ARP) de Bogotá, Colombia

    OpenAIRE

    Cortes Iza, Sandra Catalina; Espinosa Muñoz, Yiseth Andrea; Montenegro Castillo, María Juliana

    2010-01-01

    A lo largo de la historia se ha encontrado que el dolor lumbar agudo es una patología de alta prevalencia y costo, lo ha llevado a varios países a considerarlo un problema de salud pública, Sin embargo ha sido subvalorada y aun no se toman las medidas preventivas lo que aumenta los costos de atención para los servicios de salud y para las empresas es una causa importante de disminución de la producción por días de incapacidad. Con el fin de establecer si el tiempo de inicio y tipo del trat...

  5. Transversus abdominis plane block: A multimodal analgesia technique – Our experience

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    Deepak Dwivedi

    2017-01-01

    Full Text Available Context: A retrospective observational study conducted to assess transversus abdominis plane (TAP block as a tool for providing multimodal analgesia postoperatively for abdominal surgeries. Aims: The aim is to compare the visual analog scale (VAS of pain and the requirement of rescue analgesia postoperatively in patients undergoing various abdominal surgeries (open and laparoscopic where TAP block was given for postoperative analgesia and was compared with patients who received pain relief according to the institutional protocol. Settings and Design: Retrospective observational study conducted in a tertiary care hospital. Subjects and Methods: Retrospective data from anesthesia records of patients, who underwent abdominal surgeries from January 2016 to December 2016, were analyzed and were divided into two groups. Group A (n = 250 consisted of patients who received the conventional standard postoperative analgesia protocol of the department of anesthesia. Group B (n = 136 consisted of patients who were administered TAP block postsurgery for the postoperative analgesia by the trained anesthesiologist. Primary outcome considered was (i average VAS at 02, 06, 12, and 24 h and (ii average opioid/nonsteroidal anti-inflammatory drug consumption at 24 h postoperatively. Secondary outcome considered was time to first rescue analgesia. Statistical Analysis: All parametric data were analyzed using unpaired t-test. Data are expressed as the mean ± standard deviation. A SPSS version 17 (SPSS Inc., Chicago, IL, USA was used for statistical analysis. Results: Average pain scores (VAS were lower in Group B as compared to Group A in all subcategories of surgery postoperatively. Patients given TAP block (Group B required less rescue analgesia in the postoperative period with time to first rescue analgesia being prolonged. Conclusions: On the basis of our retrospective study, we suggest that TAP block can be utilized as a part of multimodal analgesia regimen for

  6. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Jung, Young Jin [Soonchunhyang University, Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Jang, Yun Woo [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2006-04-15

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 {mu} m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  7. Usefulness of modified intravenous analgesia: initial experience in uterine artery embolization for leiomyomata

    International Nuclear Information System (INIS)

    Yang, Seung Boo; Jung, Young Jin; Goo, Dong Erk; Jang, Yun Woo

    2006-01-01

    We wanted to evaluate the usefulness of modified intravenous analgesia for the management of pain during uterine artery embolization for leiomyomata. Between April 2004 and July 2004, 15 patients with symptomatic fibroids underwent uterine artery embolization and pain management. Except the three patients for whom the Visual Analogue Scale (VAS) score was not obtained, twelve patients were included in this study. For pain management, epidural PCA (Patient Controlled Analgesia) was used in two patients, intravenous PCA was used in two patients and modified intravenous analgesia injection was used in eight patients. For all the patients, we used the 2.8 Fr coaxial microcatheter and 500-710 μ m PVA particles for the embolic materials. The protocol of the modified intravenous analgesia injection was as follow, 1) prior to femoral artery puncture, 30 mg of ketorolac tromethamine (Tarasyn)was injected via an intravenous route. 2) At the time that the one side uterine artery embolization was finished, normal saline mixed 150 mg meperidine (Demerol) was administered through the side port of the intravenous line that was used for hydration. 3) Additional ketorolac tromethamine 30 mg was injected after 6 hour. The VAS score and side effects were then checked. After 12 hours, the VAS score was rechecked. If the VAS score was above 4, this was considered as failure of pain management. The VAS scores, complications and side effects for the modified intravenous analgesia injection were compared with that of IV PCA and epidural PCA. The average VAS score of the modified intravenous analgesia injection, intravenous PCA and epidural PCA was 1.4, 1 and 0, respectively; the number of additional intramuscular injections of analgesia was 0.5, 0.5 and 0, respectively. All the patients who underwent epidural PCA had back pain at the puncture site and 1 patient who underwent modified intravenous analgesia injection experienced mild dyspnea, but they easily recovered with such

  8. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

    OpenAIRE

    P K Dilesh; S Eapen; S Kiran; Vivek Chopra

    2014-01-01

    Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this s...

  9. Postarthroscopy analgesia using intraarticular levobupivacaine and intravenous dexketoprofen trometamol.

    Science.gov (United States)

    Sahin, Sevtap Hekimoglu; Memiş, Dilek; Celik, Erkan; Sut, Necdet

    2015-12-01

    The aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia. Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively. The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone. II.

  10. The effect of Hegu acupoint stimulation in dental acupuncture analgesia

    Directory of Open Access Journals (Sweden)

    Fransiskus Andrianto

    2007-03-01

    Full Text Available In daily life, dental treatments are often related with oral pain sensation which needs anesthesia procedures. Sometimes local anesthetics can not be used because patients have hypersensitive reaction or systemic diseases which may lead to complications. Stimulating acupoint, such as Hegu activates hypothalamus and pituitary gland to release endogenous opioid peptide substances that reduce pain sensitivity. The aim of the study was to determine Hegu acupoint stimulation effect on the pain sensitivity reduction in maxillary central incisor gingiva. The laboratory experimental research was conducted on 12 healthy male Wistar rats (3 months old, weights 150–200 grams. All rat samples received the same treatments and adapted within 1 month. The research was done in pre and post test control group design. 40-Volt electro-stimulation was done once on the maxillary central incisor gingiva prior to the bilateral Hegu acupoint stimulation, then followed by 3 times electro-stimulation with 3 minutes intervals. The pain scores were obtained based on the samples’ contraction in each electro-stimulation. The responses were categorized into 5 pain scores and statistically analyzed using Wilcoxon Test. The results showed that Hegu acupoint stimulation lowered the pain scores significantly (p < 0.05. Hegu acupoint stimulation could reduce the pain sensitivity in maxillary central incisor gingiva. Therefore, the use of acupuncture analgesia in dental pain management can be considered in the future.

  11. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C.

    2003-01-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127

  12. Auricular Acupuncture Analgesia in Thoracic Trauma: A Case Report

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    Georgios S. Papadopoulos

    2017-02-01

    Full Text Available We report a case of thoracic trauma (rib fractures with pneumothorax and pulmonary contusions with severe chest pain leading to ineffective ventilation and oxygenation. The patient presented to our emergency department. The patient had chronic obstructive pulmonary disease and was completely unable to take deep breaths and clear secretions from his bronchial tree. After obtaining informed consent, we applied auricular acupuncture to ameliorate pain and hopefully improve his functional ability to cough and breathe deeply. Within a few minutes, his pain scores diminished considerably, and his ventilation and oxygenation indices improved to safe limits. Auricular acupuncture analgesia lasted for several hours. Parallel to pain reduction, hemodynamic disturbances and anxiety significantly resolved. A second treatment nearly a day later resulted in almost complete resolution of pain that lasted at least 5 days and permitted adequate ventilation, restored oxygenation, and some degree of mobilization (although restricted due to a compression fracture of a lumbar vertebra. Nonopioid and opioid analgesics were sparsely used in low doses during the entire hospitalization period. Hemodynamic alterations and anxiety also decreased, and the patient was soon ready to be discharged.

  13. Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

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    Nils Bjerregaard

    2012-01-01

    Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.

  14. Sex-dependent effects of cannabis-induced analgesia.

    Science.gov (United States)

    Cooper, Ziva D; Haney, Margaret

    2016-10-01

    Preclinical studies demonstrate that cannabinoid-mediated antinociceptive effects vary according to sex; it is unknown if these findings extend to humans. This retrospective analysis compared the analgesic, subjective and physiological effects of active cannabis (3.56-5.60% THC) and inactive cannabis (0.00% THC) in male (N=21) and female (N=21) cannabis smokers under double-blind, placebo-controlled conditions. Pain response was measured using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4°C); times to report pain (pain sensitivity) and withdraw the hand (pain tolerance) were recorded. Subjective drug ratings were also measured. Among men, active cannabis significantly decreased pain sensitivity relative to inactive cannabis (pcannabis failed to decrease pain sensitivity relative to inactive. Active cannabis increased pain tolerance in both men women immediately after smoking (pcannabis also increased subjective ratings of cannabis associated with abuse liability ('Take again,' 'Liking,' 'Good drug effect'), drug strength, and 'High' relative to inactive in both men and women (pcannabis smokers, men exhibit greater cannabis-induced analgesia relative to women. These sex-dependent differences are independent of cannabis-elicited subjective effects associated with abuse-liability, which were consistent between men and women. As such, sex-dependent differences in cannabis's analgesic effects are an important consideration that warrants further investigation when considering the potential therapeutic effects of cannabinoids for pain relief. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  16. Labor epidural analgesia is independent risk factor for neonatal pyrexia.

    Science.gov (United States)

    Agakidis, Charalampos; Agakidou, Eleni; Philip Thomas, Sumesh; Murthy, Prashanth; John Lloyd, David

    2011-09-01

    To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia. Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group). Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9-6.3, p neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.

  17. Anesthesia and analgesia for caesaren section in dog

    Directory of Open Access Journals (Sweden)

    Vasiljević Maja

    2014-01-01

    Full Text Available This work presents a case of a pregnant female dog, of English bulldog breed, three years old, which was brought to Belgrade Faculty of Veterinary Medicine because of inability for normal parturition. Cesarean section is an urgent intervention both in human and in veterinary medicine. Anesthesia of a pregnant dog should be carried out very carefully, because of all the physiological changes that appear during pregnancy, as well as the impact of anesthetics on embryos themselves. Anesthetics, analgesics and sedatives pass through blood brain barrier, but also their transport goes through placenta to embryo, so for that reason it is not possible to anesthetize only mother and to avoid anesthesia effects on the embryo. Therefore, anesthetics with short time of action which metabolize quickly and have minimal negative effect on embryos are recommended. When choosing the right analgesics and anesthetics, there should be known that female dogs in which it is necessary to do Cesarean section belong to the group of high risk patients. Pregnant female dogs are exposed to hypoventilation, hypoxia, hypercapnia, intense heart work, vomiting and regurgitation as well. Reversible anesthetics are recommended to provide shorter duration time of anesthesia, and in accordance, inhalation anesthetics doses are minimal. Application of α2- agonist in premedication, propophol in induction, as well as maintaining general inhalation anesthesia with sevofluran, along with local analgesia, proved to be the ideal combination in this case of cesarean section.

  18. Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients.

    Science.gov (United States)

    Niraj, G; Kelkar, Aditi; Hart, Elaine; Kaushik, Vipul; Fleet, Danny; Jameson, John

    2015-11-01

    Transversus abdominis plane (TAP) blocks have been reported to be an effective method of providing analgesia after abdominal surgery. To perform a prospective audit on the effectiveness of a novel technique of providing continuous transversus abdominis plane (TAP) analgesia in patients undergoing emergency and elective abdominal surgery. Prospective single center audit over a 3-year period. University hospital. One hundred twenty-four American Society of Anesthesiologists I to IV adult patients presenting for elective as well as emergency abdominal surgery in whom epidural analgesia was contraindicated or refused. Four quadrant TAP blocks and continuous TAP analgesia. Numerical rating scale pain scores at rest and on coughing, nausea scores, satisfaction scores, complications, frequency of analgesia failure, therapeutic failure with continuous TAP analgesia and opioid consumption. One hundred twenty-four patients who received continuous TAP analgesia were audited. This included 34 patients for elective open surgery, 36 patients for emergency laparotomy, and 54 patients who underwent elective laparoscopic colorectal surgery. Surgical incision was within the dermatomal limit of the block in 70% of the patients (88/124). Therapeutic failure with the technique was 10%. Frequency of analgesic failure over the 48-hour period was none in 39% and below 5 episodes in 57%. Four quadrant transversus abdominis plane blocks and continuous TAP analgesia is an effective technique for providing postoperative analgesia after abdominal surgery. It has the potential to be used as a sole analgesic technique when the surgical incision is within its dermatomal limit. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

    1996-01-01

    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp......To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age...

  20. Videojuego con Realidad Virtual

    OpenAIRE

    González Mora, César

    2017-01-01

    El objetivo del proyecto es el desarrollo de un videojuego deportivo que utilice realidad mixta. El videojuego se podrá utilizar con dispositivos de tipo cardboard, y utilizará realidad aumentada para la interacción del jugador con el videojuego. En el desarrollo se utilizará el motor Unity para conseguir una aplicación multiplataforma, y la librería Vuforia para implementar realidad mixta.

  1. Sistemas integrados con Arduino

    OpenAIRE

    EL YAKOUTI, MOHAMMED

    2017-01-01

    Design of a robot prototype remotely controllable from Bluetooth using Arduino. Control and testing of sensors and events interacting with Arduino and Bluetooth. Diseño de un prototipo de robot controlable remotamente con Bluetooth utilizando Arduino. Control y verificación de los sensores y eventos que interactúan mediante el Arduino y el Bluetooth. El Yakouti, M. (2017). Sistemas integrados con Arduino. http://hdl.handle.net/10251/89274. TFGM

  2. Investigando con personas con dificultades de aprendizaje

    Directory of Open Access Journals (Sweden)

    Borja González Luna

    2013-12-01

    Full Text Available El artículo muestra los orígenes de lo que Walmsley (2008 denomina «investigación inclusiva». Para comprender qué se entiende por investigación inclusiva tenemos que remontarnos a los debates epistemológicos sobre las metodologías cuantitativas y cualitativas, acontecidos en la década de los 90, en torno a la revista Disability & Society. A partir de una síntesis de dichos debates, focalizados en el ámbito de la «discapacidad intelectual y del desarrollo», se exponen dos estrategias de colaboración con dicha población: a una aproximación etnográfica (de trabajo grupal, y b una aproximación biográfica (de trabajo individual. A continuación se esboza un posible diseño de trabajo de campo que intenta superar el paradigma cualitativo «clásico» con el objetivo de incluir a dicho colectivo más allá del rol de «sujetos de la investigación». Para finalizar se recoge el debate sobre la accesibilidad de los resultados de la investigación a los participantes en dichas investigaciones, y con ello la necesaria innovación en el ámbito de las «devoluciones» de los resultados, cuando se trata de incluir a personas que presentan limitaciones para la comprensión del lenguaje abstracto oral y/o escrito.

  3. Efficacy of Subcutaneous Morphine Patient Controlled Analgesia Compared to Intravenous Morphine Patient Controlled Analgesia on Cesarean Section

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    Made Wiryana

    2017-09-01

    Result: Morphine consumption in IV-PCA group showed lower needs than SC-PCA (9.41 mg vs 4,9mg p <0.001 24 at 24 hours postoperatively. The VAS at resting at 4th hours statistically significantly lower in IV-PCA group (1.06 ± 0.71 vs 0.81 ± 1.40, p=0.029 and at 8th hours (1.03 ± 0.59 vs 0.94 ± 0,9, p=0.048. The moving VAS at 4th hours statistically significant lower in IV-PCA group (2.31 ± 0.47 vs 1.45 ± 2.06, p=0.019 but the static or VAS at moving are not different clinically. Side effects of nausea and vomiting are more common in IV-PCA group. We conclude that SC-PCA provide analgesia more effective and decreases side effects in patients undergo sectio cesarea with spinal anesthesia.

  4. Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-10-01

    ésica eficaz y que permita la movilidad precoz, la participación en las actividades de rehabilitación, y una rápida recuperación funcional. El objetivo de este estudio, fue comparar los efectos de las técnicas de analgesia controlada por el paciente (ACP, por las vías epidural y perineural del plexo lumbar sobre la rehabilitación funcional en pacientes sometidos a la ATC. MÉTODO: Pacientes en estado físico ASA I a III, que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. Para la ATC, se realizó la anestesia epidural lumbar continua con ropivacaína a 0,5% (Epidural o bloqueo continuo del plexo lumbar con ropivacaína a 0,5% (Lumbar. En la sala de recuperación, se inició ACP con infusión de ropivacaína a 0,2% (Lumbar o ropivacaína a 0,2% + fentanil 3 µg.mL-1 (Epidural. La eficacia de la analgesia en las primeras 48 horas después de la ATC (niveles de dolor, consumo de morfina de rescate y de bolos de la bomba de ACP, se comparó entre los grupos. Los diferentes parámetros de la rehabilitación postoperatoria también se estudiaron. RESULTADOS: Cuarenta y un pacientes se sometieron al análisis estadístico. Los niveles de dolor en reposo fueron similares en los dos grupos. A pesar de un control más efectivo del dolor dinámico en el grupo Epidural y de un uso más potente de la morfina, que se aplicó más a menudo y precozmente en el grupo Lumbar, no hubo diferencia entre los grupos en ninguno de los parámetros estudiados de rehabilitación. Las técnicas de analgesia no influyeron en las fallas en el proceso de rehabilitación. CONCLUSIONES: El más alto nivel de efectividad de la analgesia epidural, no se tradujo en una mejoría en el proceso de rehabilitación, ni tampoco redujo el tiempo necesario para alcanzar los resultados estudiados.BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation

  5. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

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    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

  6. Autoradiographic visualization on the role of central 3H-5-hydroxytryptamine in acupuncture analgesia

    International Nuclear Information System (INIS)

    Zhu Shoupeng; Shi Fuxi; Liu Zhonghao; Jiang Ji

    1990-10-01

    The role played by central 5-hydroxytryptamine (5-HT) in electroacupuncture analgesia has been studied in rats by means of autoradiography with isotopic tracers 3 H-5-HT. The purpose of the study is to determine the localization of 3 H-5-HT in the midbrain raphe nuclei and in the mesencephalon aquaeduct as well as periaquaeductal gray matter. Parallel experiments were studied by freezing microautoradiographic method and histo-fixative microautoradiographic method. The analgesic effect of acupuncture can be enhanced or lowered by the increment or the decrement of the 5-HT level in the midbrain raphe nuclei and in the mesencephalon aquaeduct as well as periaquaeductal gray matter. The results show that when the rats were subjected to electro-acupuncture analgesia, the microautoradiographic intensities of 3 H-5-HT both in the midbrain raphe nuclei and in the areas of mesencephalon aqueduct were significantly increased. It may be observed that the release of 5-HT in these regions of the brain is accelerated during acupuncture analgesia. From this it can be concluded that the midbrain raphe nuclei and the mesencephalon aquaeduct as well as the periaquaeductal gray matter are closely related to acupuncture analgesia. The results imply that 5-HT in these areas may be one of the most important neurochemical agents mediating acupuncture analgesia

  7. Effects of Multimodal Analgesia on the Success of Mouse Embryo Transfer Surgery

    Science.gov (United States)

    Parker, John M.; Austin, Jamie; Wilkerson, James; Carbone, Larry

    2011-01-01

    Multimodal analgesia is promoted as the best practice pain management for invasive animal research procedures. Universal acceptance and incorporation of multimodal analgesia requires assessing potential effects on study outcome. The focus of this study was to assess effects on embryo survival after multimodal analgesia comprising an opioid and nonsteroidal antiinflammatory drug (NSAID) compared with opioid-only analgesia during embryo transfer procedures in transgenic mouse production. Mice were assigned to receive either carprofen (5 mg/kg) with buprenorphine (0.1 mg/kg; CB) or vehicle with buprenorphine (0.1 mg/kg; VB) in a prospective, double-blinded placebo controlled clinical trial. Data were analyzed in surgical sets of 1 to 3 female mice receiving embryos chimeric for a shared targeted embryonic stem-cell clone and host blastocyst cells. A total of 99 surgical sets were analyzed, comprising 199 Crl:CD1 female mice and their 996 offspring. Neither yield (pups weaned per embryo implanted in the surgical set) nor birth rate (average number of pups weaned per dam in the set) differed significantly between the CB and VB conditions. Multimodal opioid–NSAID analgesia appears to have no significant positive or negative effect on the success of producing novel lines of transgenic mice by blastocyst transfer. PMID:21838973

  8. Effects of Flurbiprofen Axetil on Postoperative Analgesia and Cytokines in Peripheral Blood of Thoracotomy Patients.

    Science.gov (United States)

    Zhou, Mi; Li, Beiping; Kong, Ming

    2015-06-01

    The objective is to study the effects of flurbiprofen axetil (FA) with fentanyl together in postoperative controlled intravenous analgesia (PCIA) on pain intensity, cytokine levels in peripheral blood and adverse reactions of thoracotomy patients. Fifty thoracotomy patients were divided into a FA and a control group, each with 25 cases. Postoperative analgesia was administered in the two groups using PCIA. The pressing times of analgesia pump, the visual analog scale (VAS) scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery and the incidence of adverse drug reactions were recorded. Levels of IL-1β, IL-6, IL-8, IL-2, and TNF-α in peripheral blood were determined before the administration of FA (T0), and at 24 h (T1), 48 h (T2), 72 h (T3) after surgery. The analgesia pump pressing times in the FA group was less than that of the control group. The VAS scores during resting and coughing at 2, 6, 24, 48, 72 h after surgery, were statistically less than those of control group. The incidence rate of nausea and vomiting was insignificantly different between the two groups. Administration of FA together with PCIA in thoracotomy patients can improve postoperative analgesia.

  9. Combined spinal-epidural analgesia in labour: its effects on delivery outcome

    Directory of Open Access Journals (Sweden)

    Suneet Kaur Sra Charanjit Singh

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

  10. Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: Retrospective analysis.

    Science.gov (United States)

    Weingarten, Toby N; Del Mundo, Serena B; Yeoh, Tze Yeng; Scavonetto, Federica; Leibovich, Bradley C; Sprung, Juraj

    2014-10-01

    The aim of this retrospective study is to test the hypothesis that the use of spinal analgesia shortens the length of hospital stay after partial nephrectomy. We reviewed all patients undergoing partial nephrectomy for malignancy through flank incision between January 1, 2008, and June 30, 2011. We excluded patients who underwent tumor thrombectomy, used sustained-release opioids, or had general anesthesia supplemented by epidural analgesia. Patients were grouped into "spinal" (intrathecal opioid injection for postoperative analgesia) versus "general anesthetic" group, and "early" discharge group (within 3 postoperative days) versus "late" group. Association between demographics, patient physical status, anesthetic techniques, and surgical complexity and hospital stay were analyzed using multivariable logistic regression analysis. Of 380 patients, 158 (41.6%) were discharged "early" and 151 (39.7%) were "spinal" cases. Both spinal and early discharge groups had better postoperative pain control and used less postoperative systemic opioids. Spinal analgesia was associated with early hospital discharge, odds ratio 1.52, (95% confidence interval 1.00-2.30), P = 0.05, but in adjusted analysis was no longer associated with early discharge, 1.16 (0.73-1.86), P = 0.52. Early discharge was associated with calendar year, with more recent years being associated with early discharge. Spinal analgesia combined with general anesthesia was associated with improved postoperative pain control during the 1(st) postoperative day, but not with shorter hospital stay following partial nephrectomy. Therefore, unaccounted practice changes that occurred during more recent times affected hospital stay.

  11. Retrospective study of the association between epidural analgesia during labour and complications for the newborn.

    Science.gov (United States)

    Herrera-Gómez, A; García-Martínez, O; Ramos-Torrecillas, J; De Luna-Bertos, E; Ruiz, C; Ocaña-Peinado, F M

    2015-06-01

    our objective was to determine the association between epidural analgesia and different variables. the effect on newborns of epidural analgesia administered to the mother during labour remains under debate. this association was retrospectively investigated in a cohort of 2399 children born in a Spanish public hospital. Only full-term (>37 weeks of gestation) deliveries were included. Other exclusion criteria were: induced delivery (medical or obstetric indication), elective caesarean section, or the presence of an important pregnancy risk factors (hypertension, diabetes, severe disease, toxaemia, retarded intrauterine growth, chronologically prolonged pregnancy, prolonged membrane rupture (>24 hours), oligoamnios, or polyhydramnios). The Mann-Whitney U test and Fisher׳s exact test were applied to determine the relationship between variables. Apgar index values at one minute and five minutes were slightly but significantly lower in neonates whose mothers had received epidural analgesia. Neonatal intensive care unit admission was significantly more frequent in the epidural versus non-epidural group. Resuscitation was significantly more frequent in the epidural versus non-epidural group. Early breast feeding onset was more frequent in the non-epidural group. The adverse effect of epidural analgesia on early lactation remained significant after adjusting for NICU admission and the need for resuscitation in a logistic regression analysis. Epidural analgesia may have adverse effects on newborns, although the risks are low, and further research is required to elucidate the causal nature of this relationship. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

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    Piedrahíta-Gutiérrez, Dany Leandro

    2016-07-01

    Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

  13. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

    Directory of Open Access Journals (Sweden)

    Pritam Yadav

    2018-01-01

    Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

  14. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

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    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  15. Efficacy of tramadol versus fentanyl for postoperative analgesia in neonates.

    Science.gov (United States)

    Alencar, Ana Julia Couto; Sanudo, Adriana; Sampaio, Virginia Maria Ramos; Góis, Rôsicler Pereira; Benevides, Fernando Antônio Barbosa; Guinsburg, Ruth

    2012-01-01

    To assess, in newborn infants submitted to surgical procedures, the efficacy of two opioids-fentanyl and tramadol-regarding time to extubate, time to achieve 100 ml/kg of enteral feeding and pain in the first 72 h after surgery. Controlled, blind, randomised clinical trial. Neonatal intensive care unit. 160 newborn infants up to 28 days of life requiring major or minor surgeries. Patients were randomised to receive analgesia with fentanyl (1-2 μg/kg/h intravenously) or tramadol (0.1-0.2 mg/kg/h intravenously) in the first 72 h of the postoperative period, stratified by surgical size and by patient's gender. Pain assessed by validated neonatal scales (Crying, Requires oxygen, Increased vital signs, Expression and Sleepless Scale and the Neonatal Facial Coding System), time until extubation and time to reach 100 ml/kg enteral feeding. Statistical analysis included repeated measures analysis of variance adjusted for confounding variables and Kaplan-Meier curve adjusted by a Cox model of proportional risks. Neonatal characteristics were (mean±SD) birth weight of 2924±702 g, gestational age of 37.6±2.2 weeks and age at surgery of 199±63 h. The main indication of surgery was gastrointestinal malformation (85 newborns; 53%). Neonates who received fentanyl or tramadol were similar regarding time until extubation, time to reach 100 ml/kg of enteral feeding and pain scores in the first 72 h after surgery. Tramadol was as effective as fentanyl for postoperative pain relief in neonates but does not appear to offer advantages over fentanyl regarding the duration of mechanical ventilation and time to reach full enteral feeding. Trial registration NCT00713726.

  16. Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.

    Science.gov (United States)

    Sharara-Chami, Rana; Lakissian, Zavi; Charafeddine, Lama; Milad, Nadine; El-Hout, Yaser

    2017-12-01

    There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities. This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time. Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB ( P = .009 and P = .002, respectively). Interrater reliability was κ = 0.843. Significant increase in heart rate (139.27 [9.63] to 163 [13.23] beats per minute) and crying time (5.78 [6.4] to 45.37 [12.39] seconds) were noted in the EMLA group. During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream. Copyright © 2017 by the American Academy of Pediatrics.

  17. Epidural analgesia during labor among immigrant women in Sweden.

    Science.gov (United States)

    Ekéus, Cecilia; Cnattingius, Sven; Hjern, Anders

    2010-01-01

    To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Population-based register study. Nationwide study in Sweden. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Register study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers. Use of EDA during vaginal delivery. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women. EDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.

  18. The study of patient controlled analgesia undergoing interventional therapy for gynecology and obstetrics ailment

    International Nuclear Information System (INIS)

    She Shouzhang

    2006-01-01

    Uterine artery embolism is widely used for interventional therapy of gynecology and obstetrics ailment, but immediate incidence of pain occurs in 90% to 100% after uterine artery embolism and postoperative incidence of pain takes place from 80% to 90%. Patient controlled epidural analgesia (PCEA) could be adopted to treat pain with obviously outweighed effects over the traditional drug regimen or patient intravenous analgesia during the period of interventional therapy of uterine artery embolization. PCEA possesses good effect of analgesia and less adverse reaction and furthermore could eliminate or lessen the sufferings of patient and thus improve rehabilitation quality. Adding droperidol (0.005%) into the preparation of PCEA could decrease adverse effect incidence of nausea and vomiting; so it deserves recommendation for extending application in clinical interventional therapy. (authors)

  19. Assessment of buprenorphine, carprofen, and their combination for postoperative analgesia in olive baboons (Papio anubis).

    Science.gov (United States)

    Allison, Sarah O; Halliday, Lisa C; French, Jeffrey A; Novikov, Dmitri D; Fortman, Jeffrey D

    2007-05-01

    This study compared the efficacy of buprenorphine, carprofen, and a combination of the 2 analgesics in female baboons. Physiologic and behavioral parameters were assessed at baseline and postoperatively for 6 d by use of continuous noninvasive physiologic monitoring and twice-daily videotaping. Prior to surgery, all animals received a pre-emptive dose of either 0.01 mg/kg buprenorphine intramuscularly, 2.2 mg/kg carprofen intramuscularly, or a combination of 0.01 mg/kg buprenorphine and 2.2 mg/kg carprofen intramuscularly. All animals in the carprofen (n = 4) and buprenorphine+carprofen (n = 4) treatment groups appeared to have sufficient analgesia. Three of 4 animals in the buprenorphine group had adequate analgesia. The fourth animal had an elevated heart rate and spent less time standing during the postoperative period. In this study, the use of carprofen or a combination of carprofen plus buprenorphine provided more reliable postoperative analgesia than buprenorphine alone.

  20. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg

    Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour...... of an antenatal education program in small classes on use of epidural analgesia. Methods: Data from the NEWBORN trial were used. A total of 1766 women from the Copenhagen area, Denmark were randomized to participate in either antenatal education in small groups or standard care. Data were analysed according...... on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour...

  1. Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Pei-Ching Hung

    2007-10-01

    Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

  2. Molecular and cellular mechanisms of the age-dependency of opioid analgesia and tolerance

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    Zhao Jing

    2012-05-01

    Full Text Available Abstract The age-dependency of opioid analgesia and tolerance has been noticed in both clinical observation and laboratory studies. Evidence shows that many molecular and cellular events that play essential roles in opioid analgesia and tolerance are actually age-dependent. For example, the expression and functions of endogenous opioid peptides, multiple types of opioid receptors, G protein subunits that couple to opioid receptors, and regulators of G protein signaling (RGS proteins change with development and age. Other signaling systems that are critical to opioid tolerance development, such as N-methyl-D-aspartic acid (NMDA receptors, also undergo age-related changes. It is plausible that the age-dependent expression and functions of molecules within and related to the opioid signaling pathways, as well as age-dependent cellular activity such as agonist-induced opioid receptor internalization and desensitization, eventually lead to significant age-dependent changes in opioid analgesia and tolerance development.

  3. Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia.

    Science.gov (United States)

    Franklin, Andrew D; Hughes, Elisabeth M

    2016-06-01

    Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate.

  4. Understanding Central Mechanisms of Acupuncture Analgesia Using Dynamic Quantitative Sensory Testing: A Review

    Directory of Open Access Journals (Sweden)

    Jiang-Ti Kong

    2013-01-01

    Full Text Available We discuss the emerging translational tools for the study of acupuncture analgesia with a focus on psychophysical methods. The gap between animal mechanistic studies and human clinical trials of acupuncture analgesia calls for effective translational tools that bridge neurophysiological data with meaningful clinical outcomes. Temporal summation (TS and conditioned pain modulation (CPM are two promising tools yet to be widely utilized. These psychophysical measures capture the state of the ascending facilitation and the descending inhibition of nociceptive transmission, respectively. We review the basic concepts and current methodologies underlying these measures in clinical pain research, and illustrate their application to research on acupuncture analgesia. Finally, we highlight the strengths and limitations of these research methods and make recommendations on future directions. The appropriate addition of TS and CPM to our current research armamentarium will facilitate our efforts to elucidate the central analgesic mechanisms of acupuncture in clinical populations.

  5. Obstetric regional analgesia in the Jesenice General hospital in year 2006

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    Aleksandra Kern

    2007-11-01

    Full Text Available Background: The aim of this retrospective analysis of the obstetric regional analgesia (ORA in Jesenice General Hospital in year 2006 was to evaluate our work and present results. We analysed workload, quality of the analgesia and patients’ satisfaction. We also estimated the OR for vacuum extraction (VE in nulliparous labouring women having ORA. We compared quality of analgesia and total local analgesic consumption in nulliparous women having VE or spontaneous delivery.Methods: We performed retrospective analysis of labours with ORA in year 2006. All women received epiduraly mixture of 0.1 % bupivacaine with 2 µg of fentanyl per ml in intermittent boluses.The labour pain was assessed using visual analogue scale (VAS. We used median and interquartile range to describe distribution of these values and mean with standard deviation to describe distribution of other data (local anaesthetic consumption. We considered patient with pain VAS 3 or less adequately treated, VAS 4 and 5 sufficiently and VAS 6 and more insufficiently treated. We used odds ratio as measurement of risk for VE, t-test for differences in local anaesthetic consumption and Mann-Whitney test to evaluate differences in pain between tested groups.Results: 225 labouring women opted for ORA or 38 % of all labouring women in year 2006. We performed 224 ORA, 59 % during regular work, 41 % during turn of duty. 18 % of ORA were performed between 10 p.m. and 7.00 a.m. In 98 % of cases epidural analgesia was used. Anaesthesiologic work took 16 minutes in average (SD 6.06. Analgesia was started at VAS median 5 (IQR 4–6.5 and at average cervical dilatation 4.1 cm (SD 1.4. Average consumption of bupivacaine was 55 mg (SD 23.7 and fentanyl 91.7 µg (SD 46.5. Most common complications were inadequate analgesia, and misplacement of epidural catheter (10/222, dural tap (6/222, and unilateral analgesia (2/222. 70 labours were ended with VE (13 %; n = 532. There were 27 (8.7 %; n = 309 VE in

  6. Evaluación pre-post de una actividad preventiva de la infección por VIH dirigida a los adolescentes de las comarcas del sur de Tarragona

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    Josep Rebull Fatsini

    2003-01-01

    Full Text Available Fundamentos: La infección por el virus de la inmunodeficiencia humana (VIH es uno de los principales problemas de salud pública que tiene nuestro país. La educación preventiva ha demostrado ser un instrumento útil en la disminución de la enfermedad. El objetivo de este trabajo es evaluar la efectividad de una intervención preventiva realizada en los Institutos de Enseñanza Secundaria (IES de las comarcas del Baix Ebre y el Montsià correspondientes a la Región Sanitaria de Tortosa, orientada a reducir el riesgo de transmisión del VIH y aumentar el conocimiento de dicha enfermedad. Método: Se realizó un estudio de intervención antes-después, sin grupo control. Se invitó a participar a 19 centros docentes, correspondientes a los cursos de 4º de Enseñanza Secundaria Obligatoria y 1º de Bachillerato. La actividad consistía en un taller de 60-90 minutos de duración, adjuntando material didáctico. El instrumento de medida fue un cuestionario. Resultados: Aceptaron participar 12 centros, obteniendo 896 respuestas en el pre-test y 805 respuestas en el post-test. En el 52 % (10/19 de los ítems se observó un incremento, estadísticamente significativo, de las respuestas correctas en el post-test. En 4 de los 5 ítems (80% sobre actitudes y en 5 de los 8 (62,5% ítems sobre conocimientos generales de la infección se observó, después de la intervención, una mejora estadísticamente significativa. Sólo en 1 de los 6 ítems (16,6% sobre los conocimientos en prevención se observó una mejoría estadísticamente significativa. Conclusiones: Las actividades preventivas en forma de talleres participativos son un buen instrumento para aumentar los conocimientos y mejorar las actitudes respecto al VIH/SIDA de los adolescentes que participan. Al no existir tratamiento curativo para esta enfermedad, la prevención desde el ámbito educativo es relevante para frenar el aumento de transmisión del VIH.

  7. Modelo multicritério de apoio a decisão para o planejamento de manutenção preventiva utilizando PROMETHEE II em situações de incerteza

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    Cristiano Alexandre Virgínio Cavalcante

    2005-08-01

    Full Text Available Ferramenta estratégica para redução dos custos e incremento da disponibilidade da planta, a Manutenção Preventiva, nos últimos anos, tem alcançado sua importância devida, com um crescimento significativo de sua aplicação nas indústrias. Apesar da existência de uma grande quantidade de modelos que tratam desta problemática, em muitas situações em que não se tem dados de falhas ou estes são pouco confiáveis e, além disso, deseja-se observar o comportamento de mais de um aspecto ao se estabelecer a periodicidade da manutenção preventiva, estes modelos fornecem resultados pouco satisfatórios. Neste contexto, este artigo traz um modelo de decisão que, fazendo uso do método multicritério PROMETHEE II e de análise Bayesiana, permite que se estabeleça a periodicidade da manutenção preventiva, observando-se o parâmetro custo e confiabilidade, além disso, permite que a ausência de dados não seja um empecilho para a estipulação destes tempos.As a strategic tool to reduce costs and increment the availability of the plant, Preventive Maintenance has become quite popular over the last years due to the significant increase of its application in industries. Despite the great quantity of models that deal with that problem, these are less than satisfactory in many situations when failure data are inexistent or not too reliable and when the observation of the conduct of more than one aspect is desirable to establish the periodicity of Preventive Maintenance. In such context, this article offers a model of decision by making use of the multicriteria method PROMETHE II and the Bayesian analysis, which allows to establish the periodicity of the Preventive Maintenance, observing the costs and reliability parameter and also permitting the lack of data not to be an impediment in the stipulation of those timings.

  8. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

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    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  9. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.

    NARCIS (Netherlands)

    Galvin, E.; Boesjes, H.; Hol, J.; Ubben, J.F.; Klein-Nulend, J.; Verbrugge, S.J.

    2010-01-01

    BACKGROUND: Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. METHODS: Patients scheduled for

  10. Local infiltration analgesia in urogenital prolapse surgery: a prospective randomized, double-blind, placebo-controlled study

    DEFF Research Database (Denmark)

    Kristensen, Billy B; Rasmussen, Yvonne H; Agerlin, Marianne

    2011-01-01

    To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique.......To evaluate the analgesic effect of high-volume infiltration analgesia in urogenital prolapse surgery and provide a detailed description of the infiltration technique....

  11. Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy.

    Science.gov (United States)

    Talamo, Giampaolo; Liao, Jason; Bayerl, Michael G; Claxton, David F; Zangari, Maurizio

    2010-03-01

    Medical literature provides only scarce data about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB), and little is known about the factors that can modify the perception of pain. In this study, we evaluated the effectiveness of a combination of analgesia and anxiolysis in reducing the pain score of patients undergoing BMAB. Eighty-four consecutive adult patients underwent BMAB after local anesthesia with 5 mL of lidocaine hydrochloride 1% aqueous solution in the left posterior superior iliac crest. Analgesia was obtained with acetaminophen 650 mg and oxycodone 10 mg, and anxiolysis was obtained with lorazepam 2 mg, all drugs given once orally 30 min before the procedure. We assessed the pain level with the Wong-Baker Faces Pain Rating Scale, which distinguishes six levels of pain, from 0 to 5. The 34 patients who received an oral administration of analgesia and anxiolysis reported pain at lower levels, i.e., in the range of 0-2, more frequently than the 50 patients who underwent BMAB without analgesia/anxiolysis (78% vs 64%, respectively). Among several predictors analyzed using a multivariate regression model, three were found to be associated with decreased pain level: the use of analgesia/anxiolysis, male sex, and increase in age (all with p values <0.05). Length of the extracted bone specimen, body mass index, and need of a spinal needle for anesthesia in obese patients did not predict for pain level. An oral administration of prophylactic regimen of analgesia and anxiolysis, at the above-mentioned doses, produced a statistically significant reduction of the perception of pain in patients undergoing BMAB, but its effect did not seem to provide a major and clinically significant reduction of pain level.

  12. Epidural analgesia in labour and neonatal respiratory distress: a case-control study.

    Science.gov (United States)

    Kumar, Manoj; Chandra, Sue; Ijaz, Zainab; Senthilselvan, Ambikaipakan

    2014-03-01

    Epidural analgesia is the commonest mode for providing pain relief in labour, with a combination of bupivacaine and fentanyl most often used in practice. To test whether late-preterm and term neonates exposed to opioids in epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period. A case-control study was conducted of singleton infants born during January 2006 to December 2010. Cases were neonates ≥34 weeks gestation, who developed respiratory distress within 24 h of life requiring supplemental oxygen ≥2 h and/or positive pressure ventilation in the neonatal intensive care unit. Controls were gestation and site-matched neonates who did not develop any respiratory distress within the same period. The information on exposure to epidural analgesia and on potential confounding variables was obtained from the standardised delivery record, routinely filled out on all women admitted to the labour wards. In our study, 206 cases and 206 matched controls were enrolled. Exposure to epidural analgesia was present in 146 (70.9%) cases as compared with 131 (63.6%) of the controls. The association between exposure to epidural analgesia and respiratory distress in neonates was statistically significant upon adjustment for all potential confounders (adjusted OR: 1.75, 95% CI 1.03 to 2.99; p = 0.04). When data was separately analysed for term and late-preterm infants, the results were consistent across these subpopulations, showing no interaction effect. Late-preterm and term infants exposed to maternal epidural analgesia in labour are more likely to develop respiratory distress in the immediate neonatal period.

  13. El cáncer colorrectal en España. Costes por incapacidad temporal y opciones preventivas desde las empresas

    Directory of Open Access Journals (Sweden)

    M.T. Vicente-Herrero

    2013-04-01

    Conclusiones: Sirvan los resultados para valorar la utilidad de la implantación de estrategias de apoyo a la sanidad pública para una mayor reducción de la prevalencia, mortalidad y mejora de la calidad de vida de los afectados y sus familias, junto con un ahorro económico derivado de la reducción de la IT derivada del cáncer colorrectal.

  14. Giochiamo con i robot

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    Andrea Bonarini

    2009-01-01

    Full Text Available "Giochiamo con i robot" e' un laboratorio interattivo per grandi e piccini realizzato per l'edizione 2007 del Festival della Scienza di Genova. Lungo un percorso che va dalla telerobotica alla robotica evolutiva, il laboratorio sviluppa il tema di dare intelligenza ai robot. Questo percorso, le cui tappe sono le varie installazioni, si conclude nella "bottega" dove e' possibile costruire e programmare i propri robot o smontare e modificare quelli esposti durante il percorso didattico. I visitatori sono coinvolti in attivita' ludiche grazie alle quali possonoentrare in contatto con alcune delle idee potenti della robotica,

  15. disegnare con ... Alberto Pratelli

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    Roberto Mingucci

    2017-12-01

    Full Text Available Con questa breve intervista ad Alberto Pratelli, (non a caso scelto per aprire questa nuova rubrica intendia-mo inaugurare un dialogo con personalità significati-ve del Disegno di Architettura, che consenta riflessioni dedicate alle sue varie dimensioni, oggi più che mai da approfondire. La suggestione a farlo, viene da un’idea di Pablo Rodri-guez Navarro ed abbiamo quindi pensato di avviarla proprio in questo numero, che Pablo ha accettato di curare su un tema a lui particolarmente caro.

  16. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Giane Nakamura

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have led to speculation that the association between ropivacaine and clonidine might be more effective than ropivacaine alone. We examined the maternal-fetal effects of two pharmacological approaches: a low dose of ropivacaine or a lower dose of ropivacaine plus clonidine for epidural analgesia during labor. DESIGN AND SETTING: Prospective study at Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Thirty-two pregnant women in American Society of Anesthesiologists physical status I and II randomly underwent epidural analgesia using 15 ml of ropivacaine 0.125% (R group or 15 ml of ropivacaine 0.0625% plus 75 µg clonidine (RC group. Pain intensity, sensory block level, latency time, motor block intensity, duration of labor analgesia and duration of epidural analgesia were evaluated. The newborns were evaluated using Apgar scores and the Amiel-Tison method (neurological and adaptive capacity score. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination. RESULTS: There were no statistically significant differences between the groups regarding pain score, sensory block level, duration of epidural analgesia or Apgar score. The latency time, duration of labor analgesia and motor block were R group < RC group. The half-hour and two-hour neurological and adaptive capacity scores were higher in the R group. All of the R group newborns and 75% of the RC group newborns were found to be neurologically healthy at the 24-hour examination

  17. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  18. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P ... for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine....

  19. Post-radiation analgesia at rats and function of endogenous opiates

    International Nuclear Information System (INIS)

    Slivkova, E.; Smajda, B.; Paulikova, E.; Lackova, M.

    2002-01-01

    In this work post-radiation analgesia at rats as well as the function of endogenous opiates were tested. Males of rats were irradiated all-body dose 6 Gy. Hot-plate test was used. Dose of 8 mg of naloxone per kg of animal blocked perception of ache. This dose blocked analgetic effect of ionising radiation. Activity of phagocyte activity and phagocyte index were enhanced at rats which obtained naloxone. Authors stated that opiate system play a significant role at analgesia induced by radiation at rats and can modify response of immunity system on the stress

  20. External cephalic version for breech presentation with or without spinal analgesia in nulliparous women at term: a randomized controlled trial.

    Science.gov (United States)

    Weiniger, Carolyn F; Ginosar, Yehuda; Elchalal, Uriel; Sharon, Einav; Nokrian, Malka; Ezra, Yossef

    2007-12-01

    To compare the success of external cephalic version using spinal analgesia with no analgesia among nulliparas. A prospective randomized controlled trial was performed in a tertiary referral center delivery suite. Nulliparous women at term requesting external cephalic version for breech presentation were randomized to receive spinal analgesia (7.5 mg bupivacaine) or no analgesia before the external cephalic version. An experienced obstetrician performed the external cephalic version. Primary outcome was successful conversion to vertex presentation. Seventy-four women were enrolled, and 70 analyzed (36 spinal, 34 no analgesia). Successful external cephalic version occurred among 24 of 36 (66.7%) women randomized to receive spinal analgesia compared with 11 of 34 (32.4%) without, P=.004 (95% confidence interval [CI] of the difference: 0.0954-0.5513). External cephalic version with spinal analgesia resulted in a lower visual analog pain score, 1.76+/-2.74 compared with 6.84+/-3.08 without, Pexternal cephalic version success was 4.0-fold higher when performed with spinal analgesia P=.02 (95% CI, odds ratio [OR] 1.2-12.9). Complete breech presentation before attempting external cephalic version increased the odds of success 8.2-fold, P=.001 (95% CI, OR 2.2-30.3). Placental position, estimated fetal weight, and maternal weight did not contribute to the success rate when spinal analgesia was used. There were no cases of placental abruption or fetal distress. Administration of spinal analgesia significantly increases the success rate of external cephalic version among nulliparous women at term, which allows possible normal vaginal delivery. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00119184 I.

  1. The possible mechanisms of protocatechuic acid-induced central analgesia

    Directory of Open Access Journals (Sweden)

    Rana Arslan

    2018-05-01

    Full Text Available It is aimed to investigate the central antinociceptive effect of protocatechuic acid and the involvement of stimulation of opioidergic, serotonin 5-HT2A/2C, α2-adrenergic and muscarinic receptors in protocatechuic acid-induced central analgesia in mice. Time-dependent antinociceptive effects of protocatechuic acid at the oral doses of 75, 150 and 300 mg/kg were tested in hot-plate (integrated supraspinal response and tail-immersion (spinal reflex tests in mice. To investigate the mechanisms of action; the mice administered 300 mg/kg protocatechuic acid (p.o. were pre-treated with non-specific opioid antagonist naloxone (5 mg/kg, i.p., serotonin 5-HT2A/2C receptor antagonist ketanserin (1 mg/kg, i.p., α2-adrenoceptor antagonist yohimbine (1 mg/kg, i.p. and non-specific muscarinic antagonist atropine (5 mg/kg, i.p., respectively. The antinociceptive effect of protocatechuic acid was observed at the doses of 75, 150 and 300 mg/kg in tail-immersion test, at the doses of 150 and 300 mg/kg in hot-plate test at different time interval. The enhancement in the latency of protocatechuic acid-induced response to thermal stimuli was antagonized by yohimbine, naloxone and atropine in tail-immersion test, while it was antagonized only by yohimbine and naloxone pretreatments in hot-plate test. These results indicated that protocatechuic acid has the central antinociceptive action that is probably organized by spinal mediated cholinergic and opiodiergic, also spinal and supraspinal mediated noradrenergic modulation. However, further studies are required to understand how protocatechuic acid organizes the interactions of these modulatory systems. As a whole, these findings reinforce that protocatechuic acid is a potential agent that might be used for pain relief. Additionally, the clarification of the effect and mechanisms of action of protocatechuic acid will contribute to new therapeutic approaches and provide guidance for new drug

  2. Conversando con Oriol Bohigas

    OpenAIRE

    Redondo Domínguez, Ernesto; Moya Sala, Joaquim

    2015-01-01

    [EN] Interview with Oriol Bohigas [ES] Entrevista con Oriol Bohigas Redondo Domínguez, E.; Moya Sala, J. (2015). Conversando con… Oriol Bohigas. EGA. Revista de Expresión Gráfica Arquitectónica. 20(26):22-35. doi:10.4995/ega.2015.4061 22 35 20 26

  3. DR Con o:

    African Journals Online (AJOL)

    which could fall under the Ugandan influence. The con-. flict in the ..... The Congolese people and international community within SADC, the AU ..... ments and make peace among themselves. However, one ... friends overnight.There is a great ...

  4. Acupuntura e analgesia: aplicações clínicas e principais acupontos Acupuncture and analgesia: clinical applications and main acupoints

    Directory of Open Access Journals (Sweden)

    Marilda Onghero Taffarel

    2009-12-01

    Full Text Available A dor é uma resposta protetora do organismo a estímulos nocivos, que resulta em efeitos indesejáveis quando não controlada. A analgesia pode ser promovida mediante a utilização de vários tipos de fármacos. No entanto, estes podem causar efeitos adversos de acordo com a espécie e condição física do paciente. A acupuntura tem se mostrado eficaz como coanalgésico pela capacidade de diminuir a quantidade de fármacos utilizados para o controle da dor e raramente ser contraindicada. Objetivou-se com este trabalho fazer uma breve revisão sobre as aplicações clínicas e os efeitos fisiológicos da acupuntura nos mecanismos da dor, bem como demonstrar os principais pontos de acupuntura utilizados para analgesia em animais. A pesquisa foi realizada em bases de dados eletrônicas por palavra-chave, durante o período de março a dezembro de 2008.Pain is a protective response of the body to harmful stimulus, which results in undesirable effects if not controlled. Analgesia can be achieved with the use of different types of drugs. However, these drugs can cause adverse effects according to species and patient physical condition. Acupuncture has been proved to be an effective analgesic adjuvant, by the capacity to decrease the amount of drug used for pain control, rarely contra-indicated. The aim of this paper was to review the physiological effects of acupuncture on pain mechanisms, and demonstrate the main acupoints used for animal analgesia. The search was done in electronic search database using key words, in 2008.

  5. Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion.

    Science.gov (United States)

    Shen, M K; Wu, Z F; Zhu, A B; He, L L; Shen, X F; Yang, J J; Feng, S W

    2013-03-01

    This trial aimed to compare the maternal and neonatal effects of remifentanil given by patient-controlled analgesia (PCA) or continuous infusion for labour analgesia. Patient controlled analgesia was administered using increasing stepwise boluses from 0.1 to 0.4 μg.kg(-1) (0.1 μg.kg(-1) increment, 2 min lockout, n = 30). Continuous infusion used rates from 0.05 to 0.2 μg.kg(-1) .min(-1) (0.05 μg.kg(-1) .min(-1) increment, n = 30). Dose increments were given on request. Women reported lowest pain scores (median (IQR [range]) of 3 (2-4 [2-5]) for PCA and 4 (3-5.25 [3-7]) for continuous infusion (p = 0.004) at 60 min after the beginning of analgesia. The mean (SD) remifentanil umbilical vein/maternal artery ratio in the PCA and infusion groups were 0.74 (0.45) vs 0.70 (0.52), respectively (p = 0.776). The mean (SD) umbilical artery/umbilical vein ratios were 0.31 (0.12) vs 0.26 (0.07), respectively (p = 0.088). Maternal and neonatal adverse reactions of remifentanil were similar between the two groups. The total remifentanil consumption (median (IQR [range]) during PCA administration was lower than continuous infusion, 1.34 (1.22-1.48 [0.89-1.69]) mg vs 1.49 (1.35-1.61 [1.12-1.70] mg; p = 0.011). The results suggest that remifentanil PCA provides better pain relief and similar placental transfer compared with continuous infusion. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  6. Acidentes perfurocortantes e medidas preventivas para hepatite B adotadas por profissionais de Enfermagem nos serviços de urgência e emergência de Teresina, Piauí

    Directory of Open Access Journals (Sweden)

    Telma Maria Evangelista de Araújo

    Full Text Available Objetivos analisar a ocorrência de acidentes perfurocortantes e as medidas preventivas associadas à hepatite B entre profissionais de Enfermagem em serviços de urgência e emergência. Métodos estudo transversal analítico com aplicação de questionário a 317 participantes de cinco hospitais públicos de Teresina, PI, em 2010. Resultados 152 (47,9% referiram ter sofrido acidente perfurocortante; entre as categorias, 27,3% dos Enfermeiros, 48,2% dos Auxiliares, 52,6% dos Técnicos de Enfermagem. A chance de um profissional de nível médio (Auxiliar ou Técnico sofrer um acidente perfurocortante é de 2,8 (1,38-5,67 vezes maior que o de nível superior (Enfermeiros. A agulha foi o instrumento causador mais frequente (77,0%. A não notificação do acidente foi expressiva entre Técnicos (67,0%, Auxiliares (70,0% e Enfermeiros (75,0%, assim como a não adoção de medidas profiláticas pós-exposição (84,9%, em média. As três categorias profissionais referiram uso de luvas como o EPI mais utilizado. Os Auxiliares de Enfermagem apresentaram o menor percentual (47,0% de esquema vacinal completo para hepatite B. Discussão um percentual expressivo de profissionais de Enfermagem sofreu acidente perfurocortante no trabalho com baixa adoção de medidas preventivas e profiláticas, reforçando a necessidade de fortalecimento de estratégias que visem à saúde do trabalhador no âmbito hospitalar.

  7. Investigación neuroquímica cerebral y aplicación preventiva para la reducción de los índices de criminalidad/Neurochemical brain research and it’s preventive application to reduce the crime statistics

    Directory of Open Access Journals (Sweden)

    Osvaldo Tieghi (Argentina

    2014-01-01

    Full Text Available Investigación neuroquímica cerebral y aplicación preventiva para la reducción de los índices de criminalidad Neurochemical brain research and it’s preventive application to reduce the crime statistics

  8. fertilizada con diferentes abonos

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Elizondo-Salazar

    2007-01-01

    Full Text Available Producción y calidad de la biomasa de morera (Morus alba fertilizada con diferentes abonos. Se llevó a cabo un experimento en la Estación Experimental “Alfredo Volio Mata” de la Universidad de Costa Rica con el fi n de evaluar la aplicación de 150 kg de N/ha/año proveniente de dos abonos orgánicos: lombriabono y compostaje; y de un fertilizante químico, sobre la producción y calidad de la biomasa de morera. El periodo experimental comprendió un ciclo de 12 meses, iniciando en julio del 2003 y fi nalizando en julio del 2004. Se utilizó una plantación de morera de 12 años de establecida con una densidad de siembra de 27.777 plantas/ ha. Se empleó un diseño de bloques completos al azar con cuatro tratamientos: dos abonos orgánicos, nitrato de amonio (33,5% N y un control. Las plantas se podaron a 0,6 m sobre el nivel del suelo al inicio del ensayo. Durante el periodo experimental, las plantas fueron podadas consecutivamente cada 90 días. Las hojas y los tallos fueron separados y analizados para determinar el contenido de materia seca y proteína cruda. La producción de materia seca fue 23% superior y el contenido de proteína cruda fue signifi cativamente mayor con el nitrógeno químico, mientras que el contenido de materia seca fue menor. No se encontraron diferencias signifi cativas entre el tratamiento control y los tratamientos orgánicos.

  9. Conservación preventiva y puesta en valor de acervos documentales de organizaciones locales en Valparaíso, Chile: el caso organizaciones deportivas

    OpenAIRE

    Herrera Paredes, Ángela

    2015-01-01

    Resumen En Valparaíso, Chile, existen desde hace muchos años organizaciones locales de diversa índole, entre ellas, las deportivas, que gradualmente han generado un extenso material documental que da cuenta de sus actividades, logros y desarrollo. Esto, con el tiempo, se constituirá en un valioso patrimonio que dará cuenta de la evolución social, urbana y política tanto de la ciudad como del país. El presente REPORTE aborda la experiencia desarrollada por el Centro de Estudios y Conservación ...

  10. Primeros análisis y conservación preventiva del registro bioarqueológico del Pukara de la Cueva (Humahuaca, Jujuy

    Directory of Open Access Journals (Sweden)

    Aranda, Claudia M.

    2012-01-01

    Full Text Available Desde el año 2006 se están desarrollando investigaciones sistemáticas en el Pukara de La Cueva. Las mismas se incluyen dentro de un proyecto que tienen por objetivos, estudiar el modo de vida de los habitantes prehispánicos de la Quebrada de La Cueva, así como también su relación con áreas cercanas (Quebrada de Humahuaca y sectores aledaños y promover la puesta en valor patrimonial de las muestras recuperadas. En ese marco, se excavó un conjunto de restos humanos siguiendo un procedimiento que incluyó la implementación de un Plan Integral de Conservación. El mismo contribuyó a la minimización de los efectos del deterioro y a sostener un manejo respetuoso de los restos mediante un adecuado tratamiento ético-profesional. En este trabajo se realiza el análisis bioarqueológico de la muestra y se describen las características principales del protocolo de conservación. Pudo establecerse la presencia de un mínimo de seis individuos, de ambos sexos y de edades variadas. Se detallan las características demográficas y paleopatológicas de la muestra, así como también se esbozan interpretaciones referidas a las prácticas mortuorias desarrolladas por los habitantes del poblado, mediante la comparación con otras prácticas identificadas en el sitio a comienzos del sigo XX. Esta investigación es la primera desarrollada en forma sistemática e integral con restos humanos del Pukara de La Cueva, lo cual le otorga especial relevancia ya que permite generar hipótesis a contrastar a futuro con nuevas muestras osteológicas y comenzar a incorporar las discusiones que se generen en el marco de la problemática arqueológica regional.

  11. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.G.E.; Bakker, S.M.; Touw, D.J.; Bemt, B.J.F van den; Scheffer, G.J.; Heesterbeek, P.J.C.; Stienstra, R.

    2017-01-01

    BACKGROUND: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unbound

  12. Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Zhang Wangping

    2017-01-01

    Full Text Available Background. Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. Methods. One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0.25, 0.5, 0.75, and 1 μg/ml of dexmedetomidine plus 0.1% ropivacaine, resp.. The onset of epidural anesthesia and stages of labor were studied, and pain was assessed using a visual analogue scale (VAS. Hemodynamic parameters and fetal heart rate were monitored. Apgar scores and umbilical artery pH were recorded. The side effects, if any, were recorded also. Results. The addition of 0.25, 0.5, and 0.75 μg/ml of dexmedetomidine to 0.1% ropivacaine provided safe and effective analgesia, but 1 μg/ml of dexmedetomidine resulted in increasing incidence of motor block. The hemodynamic parameters were similar between groups (P>0.05. Side effects in Group D were significantly higher than those in the other three groups (P<0.05. Conclusions. When dexmedetomidine is combined with 0.1% ropivacaine, the optimal concentration of dexmedetomidine is 0.5 μg/ml for epidural labor analgesia (this trial is registered with ChiCTR-OPC-16008548.

  13. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M.; Bakker, S.; Heesterbeek, P.; Van Den Bemt, B.; Scheffer, G.J.; Touw, D.; Stienstra, R.

    2016-01-01

    Background and Aims: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and

  14. Pharmacokinetics of 400 mg ropivacaine after periarticular local infiltration analgesia for total knee arthroplasty

    NARCIS (Netherlands)

    Fenten, M. G. E.; Bakker, S. M. K.; Touw, D. J.; van den Bemt, B. J. F.; Scheffer, G. J.; Heesterbeek, P. J. C.; Stienstra, R.

    Background: Although considered safe, no pharmacokinetic data of high dose, high volume local infiltration analgesia (LIA) with ropivacaine without the use of a surgical drain or intra-articular catheter have been described. The purpose of this study is to describe the maximum total and unbound

  15. A compression bandage improves local infiltration analgesia in total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse; Husted, Henrik; Otte, Niels Kristian Stahl Kri

    2008-01-01

    .2% ropivacaine infiltration analgesia were randomized to receive a compression or a non-compression bandage, and pain was assessed at rest and with mobilization at regular intervals for 24 h postoperatively. RESULTS: Pain at rest, during flexion, or on straight leg lift was lower for the first 8 h in patients...

  16. Evaluation of dexmedetomidine and fentanyl as additives to ropivacaine for epidural anesthesia and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    S Kiran

    2018-01-01

    Conclusions: Epidural anesthesia achieved with 10 μg dexmedetomidine as an additive to 0.5% ropivacaine is more effective with respect to duration and intensity of analgesia when compared to 0.5% ropivacaine alone or addition of 20 μg fentanyl to 0.5% ropivacaine.

  17. Safety of blood reinfusion after local infiltration analgesia with ropivacaine in total knee arthroplasty

    NARCIS (Netherlands)

    Thomassen, Bregje J.W.; Touw, Daan; Van Der Woude, Pieter; Van Der Flier, Rudolf E.; Veld, Bastiaan A.

    2014-01-01

    Objective: The authors hypothesized that it is safe to combine local infiltration analgesia (LIA) in total knee arthroplasty (TKA) with a retransfusion drain since ropivacaine concentrations would not exceed the arterial toxicity threshold concentrations of 4.3 mg/L for total and 0.56 mg/L for

  18. Spinal cord distribution of sup 3 H-morphine after intrathecal administration: Relationship to analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Nishio, Y.; Sinatra, R.S.; Kitahata, L.M.; Collins, J.G. (Yale Univ. School of Medicine, CT (USA))

    1989-09-01

    The distribution of intrathecally administered {sup 3}H-morphine was examined by light microscopic autoradiography in rat spinal cord and temporal changes in silver grain localization were compared with results obtained from simultaneous measurements of analgesia. After tissue processing, radio-activity was found to have penetrated in superficial as well as in deeper layers (Rexed lamina V, VII, and X) of rat spinal cord within minutes after application. Silver grain density reached maximal values at 30 min in every region of cord studied. Radioactivity decreased rapidly between 30 min and 2 hr and then more slowly over the next 24 hr. In rats tested for responses to a thermal stimulus (tail flick test), intrathecal administration of morphine (5 and 15 micrograms) resulted in significant dose dependent analgesia that peaked at 30 min and lasted up to 5 hr (P less than 0.5). There was a close relationship between analgesia and spinal cord silver grain density during the first 4 hr of the study. It is postulated that the onset of spinal morphine analgesia depends on appearance of molecules at sites of action followed by the activation of anti-nociceptive mechanisms.

  19. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study

    Directory of Open Access Journals (Sweden)

    Hossam A. ELShamaa

    2014-04-01

    Conclusion: The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

  20. Comparison of carprofen and tramadol for postoperative analgesia in dogs undergoing enucleation.

    Science.gov (United States)

    Delgado, Cherlene; Bentley, Ellison; Hetzel, Scott; Smith, Lesley J

    2014-12-15

    To compare analgesia provided by carprofen and tramadol in dogs after enucleation. Randomized, masked clinical trial. 43 dogs. Client-owned dogs admitted for routine enucleation were randomly assigned to receive either carprofen or tramadol orally 2 hours prior to surgery and 12 hours after the first dose. Dogs were scored for signs of pain at baseline (ie, before carprofen or tramadol administration) and at 0.25, 0.5, 1, 2, 4, 6, 8, 24, and 30 hours after extubation. Dogs received identical premedication and inhalation anesthesia regimens, including premedication with hydromorphone. If the total pain score was ≥ 9 (maximum possible score of 20), there was a score ≥ 3 in any of 5 behavioral categories (highest score possible per category was 3 or 4), or the visual analog scale (VAS) score was ≥ 35 (maximum possible score of 100) combined with a palpation score > 0, rescue analgesia (hydromorphone) was administered and treatment failure was recorded. No differences were found in age, sex, or baseline pain scores between groups. Significantly more dogs receiving tramadol required rescue analgesia (6/21), compared with dogs receiving carprofen (1/22). Pain and VAS scores decreased linearly over time. No significant differences were found in pain or VAS scores between groups at any time point (dogs were excluded from analysis after rescue). Results of this study suggested that carprofen, with opioid premedication, may provide more effective postoperative analgesia than tramadol in dogs undergoing enucleation.

  1. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Kehlet, H

    2014-01-01

    In recent years, there has been an increasing interest in local infiltration analgesia (LIA) as a technique to control postoperative pain. We conducted a systematic review of randomized clinical trials investigating LIA for total knee arthroplasty (TKA) and total hip arthroplasty (THA) to evaluate...

  2. Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia.

    Science.gov (United States)

    Stabille, Débora Miranda Diogo; Diogo Filho, Augusto; Mandim, Beatriz Lemos da Silva; de Araújo, Lúcio Borges; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

    2015-01-01

    The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. Addition of clonidine to bupivacaine in transversus abdominis plane block prolongs postoperative analgesia after cesarean section

    Directory of Open Access Journals (Sweden)

    Ranju Singh

    2016-01-01

    Conclusion: Addition of clonidine 1 μg/kg to 20 ml bupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative analgesic requirement, and increases maternal comfort compared to 20 ml of bupivacaine 0.25% alone.

  4. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  5. The Effect of Gabapentin on Preoperative Anxiety and Postoperative Analgesia in Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Seda Kisi

    2014-04-01

    Conclusion: We concluded that pre-emptive orally gabapentin reduced the total amount of tramadol consumption and provided effective analgesia and lower pain scores without hemodynamic side effect but did not affect the STAI-1 anxiety scores. [Cukurova Med J 2014; 39(2.000: 315-322

  6. Etoricoxib - preemptive and postoperative analgesia (EPPA in patients with laparotomy or thoracotomy - design and protocols

    Directory of Open Access Journals (Sweden)

    Hatz Rudolf

    2010-05-01

    Full Text Available Abstract Background and Objective Our objective was to report on the design and essentials of the Etoricoxib protocol- Preemptive and Postoperative Analgesia (EPPA Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy. Design and Methods The study is a 2 × 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a etoricoxib and (b placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 × 2 factorial study design. The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA. Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms. Discussion The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain. Trial registration NCT00716833

  7. Cutaneous synergistic analgesia of bupivacaine in combination with dopamine in rats.

    Science.gov (United States)

    Tzeng, Jann-Inn; Wang, Jieh-Neng; Wang, Jhi-Joung; Chen, Yu-Wen; Hung, Ching-Hsia

    2016-05-04

    The main goal of the study was to investigate the interaction between bupivacaine and dopamine on local analgesia. After the blockade of the cutaneous trunci muscle reflex (CTMR) responses, which occurred following the drugs were subcutaneously injected in rats, the cutaneous analgesic effect of dopamine in a dosage-dependent fashion was compared to that of bupivacaine. Drug-drug interactions were evaluated by isobolographic methods. We showed the dose-dependent effects of dopamine on infiltrative cutaneous analgesia. On the 50% effective dose (ED50) basis, the rank of drug potency was bupivacaine (1.99 [1.92-2.09] μmol/kg) greater than dopamine (190 [181-203] μmol/kg) (Pbupivacaine. The addition of dopamine to the bupivacaine solution exhibited a synergistic effect. Our pre-clinical data showed that dopamine produced a dose-dependent effect in producing cutaneous analgesia. When compared with bupivacaine, dopamine produced a lesser potency with a similar duration of cutaneous analgesia. Dopamine added to the bupivacaine preparation resulted in a synergistic analgesic effect. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine

  9. The effects of intrathecal midazolam on the duration of analgesia in ...

    African Journals Online (AJOL)

    This study was designed to evaluate the effect of 2 mg preservative-free intrathecal midazolam added to spinal bupivacaine during postoperative analgesia, and the incidence of adverse effects, if any, in patients undergoing knee arthroscopies. Method: Fifty consenting American Society of Anesthesiologists (ASA) physical ...

  10. Sex-dependent components of the analgesia produced by athletic competition.

    Science.gov (United States)

    Sternberg, W F; Bokat, C; Kass, L; Alboyadjian, A; Gracely, R H

    2001-02-01

    Competing in various athletic events (track meet, basketball game, or fencing match) can produce analgesia to cold pressor stimuli in male and female college athletes compared with baseline assessments. This competition-induced analgesia has been attributed to the stress associated with competition, which has components related to both physical exercise and the cognitive aspects of competing. This study evaluated the analgesic effect of exercise-related stress, and that caused by the cognitively stressful components of competing independent of exercise. Cold pressor pain ratings were assessed after competition in a track meet and after treadmill exercise or sedentary video game competition in both athletes and nonathletes. As expected, competing in athletics resulted in a decrease in cold pressor ratings in both male and female athletes. Independent of athletic status, treadmill running induced analgesia in women, but not in males, whereas sedentary video game competition produced analgesia in men, but not in women. These findings suggest that different components of the competitive athletic experience might be responsible for the analgesic effects in a sex-dependent manner.

  11. Introducing a patient-controlled analgesia-based acute pain relief ...

    African Journals Online (AJOL)

    The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) ...

  12. Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.

    Science.gov (United States)

    Pandazi, Ageliki; Kanellopoulos, Ilias; Kalimeris, Konstantinos; Batistaki, Chrysanthi; Nikolakopoulos, Nikolaos; Matsota, Paraskevi; Babis, George C; Kostopanagiotou, Georgia

    2013-11-01

    Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p PCA group (p PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

  13. Procedural sedation and analgesia practices by emergency physicians in the Netherlands: a nationwide survey

    NARCIS (Netherlands)

    Kuypers, Maybritt I.; Smits, Gaël J. P.; Valkenet, Suzanne C.; Thijssen, Wendy A. M. H.; Plötz, Frans B.

    2017-01-01

    Several efforts have been made to assure and to improve the quality of procedural sedation and analgesia (PSA) performed by emergency physicians (EPs) in The Netherlands. This study investigated the current PSA practice and competences of EPs in both adult and paediatric patients. In particular, if

  14. Opioid-Induced Glial Activation: Mechanisms of Activation and Implications for Opioid Analgesia, Dependence, and Reward

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    Mark R. Hutchinson

    2007-01-01

    Full Text Available This review will introduce the concept of toll-like receptor (TLR–mediated glial activation as central to all of the following: neuropathic pain, compromised acute opioid analgesia, and unwanted opioid side effects (tolerance, dependence, and reward. Attenuation of glial activation has previously been demonstrated both to alleviate exaggerated pain states induced by experimental pain models and to reduce the development of opioid tolerance. Here we demonstrate that selective acute antagonism of TLR4 results in reversal of neuropathic pain as well as potentiation of opioid analgesia. Attenuating central nervous system glial activation was also found to reduce the development of opioid dependence, and opioid reward at a behavioral (conditioned place preference and neurochemical (nucleus accumbens microdialysis of morphine-induced elevations in dopamine level of analysis. Moreover, a novel antagonism of TLR4 by (+- and (˗-isomer opioid antagonists has now been characterized, and both antiallodynic and morphine analgesia potentiating activity shown. Opioid agonists were found to also possess TLR4 agonistic activity, predictive of glial activation. Targeting glial activation is a novel and as yet clinically unexploited method for treatment of neuropathic pain. Moreover, these data indicate that attenuation of glial activation, by general or selective TLR antagonistic mechanisms, may also be a clinical method for separating the beneficial (analgesia and unwanted (tolerance, dependence, and reward actions of opioids, thereby improving the safety and efficacy of their use.

  15. COMPARATIVE STUDY OF EPIDURAL FENTANYL AND FENTANYL PLUS MAGNESIUM SULPHATE FOR POSTOPERATIVE ANALGESIA

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    Shiva

    2015-11-01

    Full Text Available AIMS AND OBJECTIVES Magnesium has antinociceptive effects in animal and human models of pain. It is found that the addition of Magnesium sulphate to postoperative Epidural infusion of Fentanyl may decrease the need for Fentanyl. We undertook a study to compare the duration of postoperative analgesia after Epidural Fentanyl and Epidural Fentanyl plus Magnesium sulphate administered postoperatively, along with side effects. MATERIALS AND METHODS 50 patients undergoing elective lower limb and abdominal surgeries were randomized into one of the two groups with 25 patients in each group. Combined Spinal Epidural Anaesthesia was used for all patients. Spinal anaesthesia with 2.5 cc of 0.5% Hyperbaric Bupivacaine was given. When sensory blockade regressed to L1, patients were given either 50 µg of Fentanyl (diluted to 6cc with normal saline, Group F or 50 µg of Fentanyl plus 50 mg Magnesium sulphate (diluted to 6cc with normal saline, Group FM. Parameters like blood pressure, pulse rate, respiratory rate and oxygen saturation were monitored, and other side effects were noted. Data were analysed by using Student t test and Chi-square/ Fisher Exact tests. RESULTS There was significant difference in duration of analgesia between Group F (107 min and Group FM (143 min. Hemodynamic parameters were stable in both the groups with minimal side effects. CONCLUSION Co-administration of Magnesium sulphate with Fentanyl for postoperative Epidural analgesia results in prolongation of Fentanyl analgesia without significant side-effects.

  16. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  17. Epidural labor analgesia: A comparison of ropivacaine 0.125% versus 0.2% with fentanyl

    Directory of Open Access Journals (Sweden)

    Yogesh Kumar Chhetty

    2013-01-01

    Conclusion: We conclude that both the concentrations of ropivacaine (0.2% and 0.125% with fentanyl are effective in producing epidural labor analgesia. However, 0.2% concentration was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids.

  18. [The influence of patient-controlled epidural analgesia on labor progress and neonatal outcome].

    Science.gov (United States)

    Rzepka, Rafał; Zukowski, Maciej; Michalczyk, Michał; Nikodemski, Tomasz; Torbé, Andrzej; Kwiatkowski, Sebastian; Mikołajek-Bedner, Wioletta; Czajka, Ryszard

    2012-02-01

    The aim of the study was to check the influence of patient control epidural analgesia on labor progress and neonatal outcome. 144 parturients were included into the clinical trial. In 73 cases patient control epidural analgesia was used and in 71 cases pethidine (meperidine) solution was given intravenously. Apgar score, umbilical artery pH, pain intensity the time of the first, second and third stage of labor the rate of episiotomy and uterine postpartum abrasions and the rate of caesarean sections and vaginal operative delivery were compared. The time of the second stage of labor was significantly longer in the study group (40.99 vs 26.49 min, p- neonatal outcome was comparable in both groups. There were no differences in the time of the first and the second stage of labor in primiparas and multiparas analyzed separately. Visual Analogue Score was lower in the study group (Ch(2)-12,48, p-0.25), especially in the subgroups of primiparas and multiparas. Patient control epidural analgesia does not affect the time of the first and second stage of labor, oxytocin augmentation of labor may be the reason of that. This method is a more effective way of relieving labor pain. An increase of operative delivery is not observed after patient control epidural analgesia on condition that low doses and concentrations of analgesic drugs are used.

  19. Propuesta metodológica de evaluación higrotérmica para la conservación preventiva del papel

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    Marí­a de la Paz Diulio

    2014-06-01

    Full Text Available Se propone un método para evaluar la calidad termo higrométrica de depósitos bibliotecarios que considere la estabilidad de las variables como complemento al cálculo del performance index. El análisis se realizó con las muestras recogidas en bibliotecas de la Universidad Nacional de La Plata en sucesivas campañas de monitoreo medioambiental donde se midió temperatura y humedad relativa interior y exterior. El resultado es una grilla donde la ubicación de cada espacio evaluado respecto a los ejes indica su estado respecto a los dos criterios que determinan la conservación de los materiales: la permanencia dentro de rangos adecuados de temperatura y humedad relativa y la variación diaria de las mismas dentro de un margen máximo admisible. Se logra establecer un nuevo agrupamiento de los edificios de acuerdo con su condición para permitir tomar medidas de acondicionamiento aplicables al grupo. Este procedimiento permite profundizar el nivel de evaluación cuando el análisis según índice de performance da resultado nulo sin permitir comprender otras variables que influyen positivamente en la conservación del papel, como es la estabilidad de los valores.

  20. Lumbosacral epidural magnesium prolongs ketamine analgesia in conscious sheep Sulfato de magnésio prolonga a analgesia epidural lombosacral induzida pela quetamina em carneiros

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    Rafael DeRossi

    2012-02-01

    Full Text Available PURPOSE: To determine the analgesic, motor, sedation and systemic effects of lumbosacral epidural magnesium sulphate added to ketamine in the sheep. METHODS: Six healthy adult male mixed-breed sheep; weighing 43 ± 5 kg and aged 20-36 months. Each sheep underwent three treatments, at least 2 weeks apart, via epidural injection: (1 ketamine (KE; 2.5 mg/kg, (2 magnesium sulphate (MG; 100 mg, and (3 KE + MG (KEMG; 2.5 mg/kg + 100 mg, respectively. Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, cardiovascular effects, respiratory rate, skin temperature, and rectal temperature were evaluated before (baseline and after drug administration as needed. RESULTS: The duration of analgesia with the lumbosacral epidural KEMG combination was 115 ± 17 min (mean ± SD, that is, more than twice that obtained with KE (41 ± 7 min or MG (29 ± 5 min alone. KE and KEMG used in this experiment induced severe ataxia. The heart rate and arterial blood pressures changes were no statistical difference in these clinically health sheep. CONCLUSION: The dose of magnesium sulphate to lumbosacral epidural ketamine in sheep is feasible, and can be used in procedures analgesics in sheep.OBJETIVO: Determinar os efeitos analgésicos, motores, sedativos e sistêmicos da adição de sulfato de magnésio na analgesia epidural com quetamina em carneiros. MÉTODOS: Foram utilizados seis carneiros machos sadios, pesando 43 ± 5 kg, com idade entre 20 a 36 meses. Cada animal recebeu três tratamentos, com duas semanas entre experimentos via administração epidural: (1 quetamina (KE; 2,5 mg/kg, (2 sulfato de magnésio (MG; 100 mg e (3 KE + MG (KEMG; 2,5 mg/kg + 100 mg, respectivamente. As administrações epidurais foram administradas no espaço lombosacral. Analgesia, bloqueio motor, sedação, efeitos cardiovasculares, freqüência respiratória, temperatura retal e de pele foram avaliados antes (basal e depois da administra

  1. pacientes con falla cardiaca

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    Diana Marcela Achury Saldaña

    2007-01-01

    Full Text Available Objetivo: determinar la adherencia al tratamiento de pacientes con falla cardiaca hospitalizados, al aplicar un plan educativo quefomenta el autocuidado.Método: estudio cuasiexperimental (entrevistas enfermera-paciente realizado entre diciembre de 2004 y mayo de 2006, con unamuestra de 50 pacientes seleccionados por conveniencia. Se diseñó un instrumento para evaluar los comportamientos de los pacientes,con base en algunos resultados de la adherencia y sus respectivos indicadores de la taxonomía NOC (Nursing out comes classification. Laadherencia al tratamiento fue medida en dos momentos: el primero durante la hospitalización, seguido de la aplicación del plan educativoantes del alta, que proporcionaba información en el manejo de su enfermedad desde una dimensión física, psicológica y social quepromueve el autocuidado; y el segundo un mes después del alta en su domicilio.Resultados: diferencias estadísticamente significativas (P=0,0001 que demuestran cómo mediante la capacitación al paciente enel manejo de su tratamiento farmacológico y no farmacológico, el establecimiento de una sana relación entre el profesional de enfermeríay el paciente, y la participación de la familia, se logra una total adherencia al tratamiento.Conclusiones: para lograr una adherencia total del paciente con falla cardiaca al tratamiento es necesario un proceso educativo y unseguimiento continuo y personalizado que motive permanentemente al paciente y se le reconozca el papel protagónico en su cuidado y manejo de la enfermedad.

  2. Comparison of morphine and carprofen administered alone or in combination for analgesia in dogs undergoing ovariohysterectomy

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    T.B. Dzikiti

    2006-06-01

    Full Text Available In this study the analgesic efficacy of the pure agonistic opioid morphine and the cyclo-oxygenase type-2-selective carprofen were compared since there is no previous specific comparative study for these two common analgesics. Forty-five bitches undergoing elective ovariohysterectomy were randomly assigned to one of three groups; receiving morphine 0.4 mg/kg bodyweight pre-operatively and 0.2 mg/kg every 4-6 hours thereafter (Morphine group, receiving a once-off carprofen 4 mg/kg injection (Carprofen group or receiving both morphine and carprofen (MorphCarp group. The dogs were premedicated with acepromazine 0.01 mg/kg and induced with either thiopentone 5-10 mg/kg or propofol 4-6 mg/kg. General anaesthesia was maintained with halothane in oxygen. The degree of pain was assessed over a 24-hour period under blinded conditions using a pain scale modified from the University of Melbourne pain scale and the Glasgow composite pain tool. Physiological parameters such as respiratory rate, pulse rate and body temperature were also assessed over the same time period. There was no significant difference in pain-scores and thus analgesia offered by the three analgesia protocols at any assessment point across the three groups, but there were differences within groups across time points. Baseline total pain-scores were lower than scores at all post-operative points within all three groups. Both morphine and carprofen provided good analgesia without any obvious adverse effects. This study indicates that at the dosages indicated above, carprofen administered on its own produces analgesia equal to that produced by morphine and that the two drugs administered together do not produce better analgesia than either drug administered on its own.

  3. Comparison of morphine and carprofen administered alone or in combination for analgesia in dogs undergoing ovariohysterectomy.

    Science.gov (United States)

    Dzikiti, T B; Joubert, K E; Venter, L J; Dzikiti, L N

    2006-09-01

    In this study the analgesic efficacy of the pure agonistic opioid morphine and the cyclo-oxygenase type-2-selective carprofen were compared since there is no previous specific comparative study for these two common analgesics. Forty-five bitches undergoing elective ovariohysterectomy were randomly assigned to one of three groups; receiving morphine 0.4 mg/kg bodyweight pre-operatively and 0.2 mg/kg every 4-6 hours thereafter (Morphine group), receiving a once-off carprofen 4 mg/kg injection (Carprofen group) or receiving both morphine and carprofen (MorphCarp group). The dogs were premedicated with acepromazine 0.01 mg/kg and induced with either thiopentone 5-10 mg/kg or propofol 4-6 mg/kg. General anaesthesia was maintained with halothane in oxygen. The degree of pain was assessed over a 24-hour period under blinded conditions using a pain scale modified from the University of Melbourne pain scale and the Glasgow composite pain tool. Physiological parameters such as respiratory rate, pulse rate and body temperature were also assessed over the same time period. There was no significant difference in pain-scores and thus analgesia offered by the three analgesia protocols at any assessment point across the three groups, but there were differences within groups across time points. Baseline total pain-scores were lower than scores at all post-operative points within all three groups. Both morphine and carprofen provided good analgesia without any obvious adverse effects. This study indicates that at the dosages indicated above, carprofen administered on its own produces analgesia equal to that produced by morphine and that the two drugs administered together do not produce better analgesia than either drug administered on its own.

  4. Effects of epidural lidocaine analgesia on labor and delivery: A randomized, prospective, controlled trial

    Directory of Open Access Journals (Sweden)

    Nafisi Shahram

    2006-12-01

    Full Text Available Abstract Background Whether epidural analgesia for labor prolongs the active-first and second labor stages and increases the risk of vacuum-assisted delivery is a controversial topic. Our study was conducted to answer the question: does lumbar epidural analgesia with lidocaine affect the progress of labor in our obstetric population? Method 395 healthy, nulliparous women, at term, presented in spontaneous labor with a singleton vertex presentation. These patients were randomized to receive analgesia either, epidural with bolus doses of 1% lidocaine or intravenous, with meperidine 25 to 50 mg when their cervix was dilated to 4 centimeters. The duration of the active-first and second stages of labor and the neonatal apgar scores were recorded, in each patient. The total number of vacuum-assisted and cesarean deliveries were also measured. Results 197 women were randomized to the epidural group. 198 women were randomized to the single-dose intravenous meperidine group. There was no statistical difference in rates of vacuum-assisted delivery rate. Cesarean deliveries, as a consequence of fetal bradycardia or dystocia, did not differ significantly between the groups. Differences in the duration of the active-first and the second stages of labor were not statistically significant. The number of newborns with 1-min and 5-min Apgar scores less than 7, did not differ significantly between both analgesia groups. Conclusion Epidural analgesia with 1% lidocaine does not prolong the active-first and second stages of labor and does not increase vacuum-assisted or cesarean delivery rate.

  5. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures.

    Science.gov (United States)

    Jensen, Courtney D; Stark, Jamie T; Jacobson, Lewis L; Powers, Jan M; Joseph, Michael F; Kinsella-Shaw, Jeffrey M; Denegar, Craig R

    2017-09-01

    Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated. Mortality was assessed with binary logistic regressions. Across the total population, mortality was 6.7%; incidence of pneumonia was 11.1%; mechanical ventilation was required in 23.8% of patients, for an average duration of 10.0 days; average stay in the hospital was 7.7 nights; and 49.7% of patients were admitted to the ICU for an average of 7.2 nights. Epidural analgesia was administered to 18.4% of patients. After matching samples for candidacy, patients who received epidurals were 3.7 years older, fractured 2.6 more ribs, had higher injury severity scores, and were more likely to present with bilateral fractures, flail segments, pulmonary contusions, hemothoraces, and pneumothoraces. Despite greater injury severity, mortality among these patients was lower (0.5%) than those who received alternative care (1.9%). Controlling for age, injury severity, and use of mechanical ventilation, epidural analgesia predicted a 97% reduction in mortality. Thoracic epidural analgesia associates with reduced mortality in rib fracture patients. Better care of this population is likely to be facilitated by more frequent reliance on this treatment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  6. Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy

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    Vladimir Vrsajkov

    Full Text Available Abstract Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38 or standard postoperative analgesia (n = 38. First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6. Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10 in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g than in the standard analgesia group (270.2 ± 81.9 g (p = 0.000. Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy.

  7. [Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy].

    Science.gov (United States)

    Vrsajkov, Vladimir; Mančić, Nedjica; Mihajlović, Dunja; Milićević, Suzana Tonković; Uvelin, Arsen; Vrsajkov, Jelena Pantić

    After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n=38) or standard postoperative analgesia (n=38). First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20mL of 0.33% bupivacaine per side before operation and tramadol 1mg.kg -1 IV for pain breakthrough (≥6). Second group received after operation tramadol 1mg.kg -1 /6h as standard hospital analgesia protocol. Both groups received acetaminophen 1g/8h IV and metamizole 2.5g/12h. Pain at rest was recorded for each patient using NR scale (0-10) in period of 10min, 30min, 2h, 4h, 8h, 12h and 16h after the surgery. We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29±47.54g) than in the standard analgesia group (270.2±81.9g) (p=0.000). Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  9. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  10. Neuraxial labor analgesia for vaginal delivery and its effects on childhood learning disabilities.

    Science.gov (United States)

    Flick, Randall P; Lee, Kunmoo; Hofer, Ryan E; Beinborn, Charles W; Hambel, Ellen M; Klein, Melissa K; Gunn, Paul W; Wilder, Robert T; Katusic, Slavica K; Schroeder, Darrell R; Warner, David O; Sprung, Juraj

    2011-06-01

    In prior work, children born to mothers who received neuraxial anesthesia for cesarean delivery had a lower incidence of subsequent learning disabilities compared with vaginal delivery. The authors speculated that neuraxial anesthesia may reduce stress responses to delivery, which could affect subsequent neurodevelopmental outcomes. To further explore this possibility, we examined the association between the use of neuraxial labor analgesia and development of childhood learning disabilities in a population-based birth cohort of children delivered vaginally. The educational and medical records of all children born to mothers residing in the area of 5 townships of Olmsted County, Minnesota from 1976 to 1982 and remaining in the community at age 5 years were reviewed to identify those with learning disabilities. Cox proportional hazards regression was used to compare the incidence of learning disabilities between children delivered vaginally with and without neuraxial labor analgesia, including analyses adjusted for factors of either potential clinical relevance or that differed between the 2 groups in univariate analysis. Of the study cohort, 4684 mothers delivered children vaginally, with 1495 receiving neuraxial labor analgesia. The presence of childhood learning disabilities in the cohort was not associated with use of labor neuraxial analgesia (adjusted hazard ratio, 1.05; 95%confidence interval, 0.85-1.31; P = 0.63). The use of neuraxial analgesia during labor and vaginal delivery was not independently associated with learning disabilities diagnosed before age 19 years. Future studies are needed to evaluate potential mechanisms of the previous finding indicating that the incidence of learning disabilities is lower in children born to mothers via cesarean delivery under neuraxial anesthesia compared with vaginal delivery.

  11. COMPARATIVE STUDY TO EVALUATE ANALGESIC EFFICACY OF CAUDAL MIDAZOLAM AND CLONIDINE POSTOPERATIVE ANALGESIA IN CHILDREN

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    Ramalinga Raju A.V.S

    2017-03-01

    Full Text Available BACKGROUND Caudal epidural analgesia is one of the most popular regional techniques used in paediatric patients undergoing lower limb, anoperineal and abdominal surgical procedures for postoperative pain relief. The aim of postoperative pain relief is to provide subjective comfort and inhibit trauma-induced nociceptive impulses to blunt autonomic and reflex responses to pain and subsequently to enhance the restoration of function. Caudal epidural analgesia though practiced widely is of short duration even when used with long-acting local anaesthetics. MATERIALS AND METHODS Children of either sex undergoing elective hernia or hydrocele surgery within in the age group of 2-8 years belonging to ASA I and II were included in the study. Informed consent was obtained from the parents before procedure. RESULTS The duration of analgesia in the study group was 10.14 ± 4.69 hrs. and 6.83 ± 0.79 hrs. in the clonidine group and midazolam group. Duration of analgesia in clonidine group was significantly longer when compared to with midazolam group with a p value of <0.05. Sedation Score- There was decrease in heart rate and mean arterial pressure from baseline, but these were under allowable limits of 20%. The patient had pain scores of less than 8 for first 6-8 hrs. The patients were well sedated and were easily arousable. CONCLUSION We conclude that in our study we found that clonidine 8 μg/kg provided good analgesia for a longer duration when compared with midazolam. Clonidine also provided good sedation with minimal haemodynamic variations. This is in agreement with studies conducted to know haemodynamic stability with higher doses of clonidine.

  12. Reduction of opioid withdrawal and potentiation of acute opioid analgesia by systemic AV411 (ibudilast).

    Science.gov (United States)

    Hutchinson, Mark R; Lewis, Susannah S; Coats, Benjamen D; Skyba, David A; Crysdale, Nicole Y; Berkelhammer, Debra L; Brzeski, Anita; Northcutt, Alexis; Vietz, Christine M; Judd, Charles M; Maier, Steven F; Watkins, Linda R; Johnson, Kirk W

    2009-02-01

    Morphine-induced glial proinflammatory responses have been documented to contribute to tolerance to opioid analgesia. Here, we examined whether drugs previously shown to suppress glial proinflammatory responses can alter other clinically relevant opioid effects; namely, withdrawal or acute analgesia. AV411 (ibudilast) and minocycline, drugs with distinct mechanisms of action that result in attenuation of glial proinflammatory responses, each reduced naloxone-precipitated withdrawal. Analysis of brain nuclei associated with opioid withdrawal revealed that morphine altered expression of glial activation markers, cytokines, chemokines, and a neurotrophic factor. AV411 attenuated many of these morphine-induced effects. AV411 also protected against spontaneous withdrawal-induced hyperactivity and weight loss recorded across a 12-day timecourse. Notably, in the spontaneous withdrawal study, AV411 treatment was delayed relative to the start of the morphine regimen so to also test whether AV411 could still be effective in the face of established morphine dependence, which it was. AV411 did not simply attenuate all opioid effects, as co-administering AV411 with morphine or oxycodone caused three-to-five-fold increases in acute analgesic potency, as revealed by leftward shifts in the analgesic dose response curves. Timecourse analyses revealed that plasma morphine levels were not altered by AV411, suggestive that potentiated analgesia was not simply due to prolongation of morphine exposure or increased plasma concentrations. These data support and extend similar potentiation of acute opioid analgesia by minocycline, again providing converging lines of evidence of glial involvement. Hence, suppression of glial proinflammatory responses can significantly reduce opioid withdrawal, while improving analgesia.

  13. Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding.

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    Gizzo, Salvatore; Di Gangi, Stefania; Saccardi, Carlo; Patrelli, Tito Silvio; Paccagnella, Gianluca; Sansone, Laura; Barbara, Favaron; D'Antona, Donato; Nardelli, Giovanni Battista

    2012-08-01

    The effect of epidural analgesia on labor and effective breastfeeding is still being debated. The aim of this study is to define its impact on the trend of labor, the newborns' well-being, and early breastfeeding. We considered first-term physiologic pregnant women who delivered by the vaginal route. We divided them into two groups: group A received epidural analgesia during labor, whereas group B received no analgesia. We recorded maternal age, gestational age, modality of delivery, length of labor, and length of active labor. All newborns received skin-to-skin contact; early breastfeeding was encouraged. We recorded data on birth weight and length, Apgar score at minutes 1 and 5, type of crying, neonatal reactivity, and time between birth and exposure to the breast. Statistical significance was considered for panalgesia, and 245 patients agreed to participate in our study. Only 128 patients met inclusion criteria. We randomized them in 64 women in group A and 64 women in group B. Data on maternal age, gestational age, type of delivery, neonatal birth weight and length, and Apgar score showed no significant differences. Total length of labor was 363.58±62.20 minutes in Group A versus 292.30±64.75 minutes in group B (pneonatal parameters we found a statistically significant difference only for length of first breastfeeding, with a mean duration of analgesia has little effect on trend of labor and duration of first breastfeed and none on neonatal outcome. A new protocol of epidural analgesia may solve these side effects.

  14. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

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    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  15. Are there any strategies to improve neonatal outcomes associated with epidural analgesia in labor?

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    Armani, Marta; Gaggiano, Carla; Dallaglio, Sara; Romanini, Enzo; Sospiri, Carmen; Magnani, Cinzia

    2013-09-01

    This study was aimed at evaluating the relationship between epidural analgesia and perinatal outcomes and at verifying the advisability of procedural changes in assistance to labor. From January to December 2012, we conducted a retrospective case-control study on 1,963 laboring pregnant women admitted to the Parma University Hospital. We considered two groups: Group 1 received epidural analgesia and Group 2 received no analgesia. Women with elective cesarean sections, multiple pregnancies or deliveries at <34 weeks were excluded. We recorded maternal data (age, type of delivery, obstetric procedures, premature rupture of membranes, screenings for Group-B Streptococcus) and neonatal data (birth weight, gestational age, 1- and 5-minute Apgar scores, diagnosis at discharge). Of the 1,963 laboring women, 287 requested analgesia and 1,676 did not. We found no significant differences between the two groups in the rates of cesarean section, clavicle fracture, and 1-minute Apgar score between 4 and 7. By contrast, we observed a higher rate of instrumental deliveries (p<0.01), fetal occiput posterior position (p<0.05), neonatal cephalohematoma (p=0.01) in Group 1 than in Group 2 . In Group 1 we also found a higher number of newborns with 1-minute Apgar score of 3 or less (p=0.016). In addition, a significantly higher number of women in Group 1 had fever during labor (p=0.003, odds ratio 5.01). Our results suggest that strategies should be activated to overcome or limit the side-effects of analgesia in labor through prospective and multidisciplinary studies. 

  16. Hypnotizability and Placebo Analgesia in Waking and Hypnosis as Modulators of Auditory Startle Responses in Healthy Women: An ERP Study.

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    De Pascalis, Vilfredo; Scacchia, Paolo

    2016-01-01

    We evaluated the influence of hypnotizability, pain expectation, placebo analgesia in waking and hypnosis on tonic pain relief. We also investigated how placebo analgesia affects somatic responses (eye blink) and N100 and P200 waves of event-related potentials (ERPs) elicited by auditory startle probes. Although expectation plays an important role in placebo and hypnotic analgesia, the neural mechanisms underlying these treatments are still poorly understood. We used the cold cup test (CCT) to induce tonic pain in 53 healthy women. Placebo analgesia was initially produced by manipulation, in which the intensity of pain induced by the CCT was surreptitiously reduced after the administration of a sham analgesic cream. Participants were then tested in waking and hypnosis under three treatments: (1) resting (Baseline); (2) CCT-alone (Pain); and (3) CCT plus placebo cream for pain relief (Placebo). For each painful treatment, we assessed pain and distress ratings, eye blink responses, N100 and P200 amplitudes. We used LORETA analysis of N100 and P200 waves, as elicited by auditory startle, to identify cortical regions sensitive to pain reduction through placebo and hypnotic analgesia. Higher pain expectation was associated with higher pain reductions. In highly hypnotizable participants placebo treatment produced significant reductions of pain and distress perception in both waking and hypnosis condition. P200 wave, during placebo analgesia, was larger in the frontal left hemisphere while placebo analgesia, during hypnosis, involved the activity of the left hemisphere including the occipital region. These findings demonstrate that hypnosis and placebo analgesia are different processes of top-down regulation. Pain reduction was associated with larger EMG startle amplitudes, N100 and P200 responses, and enhanced activity within the frontal, parietal, and anterior and posterior cingulate gyres. LORETA results showed that placebo analgesia modulated pain-responsive areas

  17. Estudo comparativo da analgesia entre bupivacaína e morfina intra-articular em osteoartrite de joelho Estudio comparativo de la analgesia entre bupivacaína y morfina intra-articular en osteoartritis de la rodilla Intra-articular bupivacaine and morphine for knee osteoarthritis analgesia. Comparative study

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    Miriam C B Gazi

    2005-10-01

    recibieron 1 mg (1 mL de morfina diluida en 9 mL de solución fisiológica a 0,9% y los del G2 (n = 21 25 mg (10 mL de bupivacaína a 0,25% sin vasoconstrictor, por vía intra-articular. La intensidad del dolor fue evaluada por la escala numérica y verbal en los tiempos 0, 30, 60 minutos y 7 días, en reposo y en movimiento. Fueron evaluados la necesidad de complementación analgésica con paracetamol (500 mg, la dosis total de analgésico utilizado, la duración de la analgesia y la calidad de la analgesia (por el paciente. RESULTADOS: De los 39 pacientes estudiados, 31 completaron el estudio. No hubo diferencia significativa de la intensidad del dolor en reposo y en movimiento entre los dos grupos en los tiempos estudiados. No hubo diferencia entre los dos grupos en el tiempo entre la administración de la solución y la necesidad de complementación analgésica. La dosis media del paracetamol utilizada en el primer día de la semana fue de 796 mg del G1 y de 950 mg en el G2; la complementación en la semana fue de 3578 mg G1 y 5333 mg en el G2. CONCLUSIONES: El efecto analgésico de 1 mg de morfina y de 25 mg de bupivacaína a 0,25% sin vasoconstrictor intra-articular fueron semejantes.BACKGROUND AND OBJECTIVES: Osteoarthritis is the most common joint disease among elderly people. This study aimed at comparing the analgesic effects of intra-articular bupivacaine and morphine in knee osteoarthritis patients. METHODS: Thirty-nine patients were included in this randomized double-blind study and divided in two groups: G1 (n = 18 patients were given intra-articular 1 mg (1 mL morphine diluted in 9 mL of 0.9% saline, while G2 (n = 21 received intra-articular 25 mg (10 mL of 0.25% plain bupivacaine. Pain intensity was evaluated by numerical and verbal scale at 0, 30, 60 minutes and 7 days at rest and in movement. Evaluated parameters were analgesic supplementation requirement with paracetamol (500 mg, total analgesic dose throughout the study, analgesia duration and quality

  18. Palliative sedation and analgesia in the terminally ill children. Report of two cases and review of the literature

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    Velasco Pérez Georgina

    2014-07-01

    Full Text Available We present the case of two children with cancer in the final stage of life, we describe the treatment given in this phase based on palliative sedation and analgesia to provide comfort to the patients and to offer calm to their relatives. We reviewed the literature information on support of sedation and analgesia at this stage of life, and the use of drugs such as midazolam and morphine. With the information provided in this article we expect physicians to convince themselves that opportune sedation and analgesia are useful and beneficial at the terminal stage of life.

  19. Vectores recombinantes basados en el virus modificado de Ankara (MVA) com vacunas preventivas y terapeúticas contra la hepatitis C

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    Esteban, Mariano; Gómez, Carmen E.; Perdiguero, Beatriz

    2014-01-01

    [ES] Los virus recombinantes de la invención contienen secuencias que se encuentran insertadas en el mismo sitio de inserción del MVA y que permiten la expresión simultáneamente de varios antígenos del VHC, concretamente las proteínas maduras estructurales (Core, E1, E2 y p7) y no estructurales (NS2, NS3, NS4A, NS4B, NS5A más los 201 aminoácidos de la región N-terminal de NS5B). Con ello se consiguen virus recombinantes estables, que permiten el desencadenamiento de una respuesta inmune contr...

  20. Investigación de accidentes y análisis de fallas de barreras preventivas; Accident’s Investigation and Preventive Barriers flaws analysis

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    Jacinto B Hernández Lavín

    2011-02-01

    Full Text Available En Cuba, como en el resto del mundo,  la existencia de leyes y regulaciones estatales, obligan a que lasempresas productivas y de servicios cuenten con un sistema de prevención de accidentes y enfermedadesprofesionales que, a partir del control de los riesgos existentes en cada puesto de trabajo, permita laboraren un ambiente seguro. En este artículo se explican las técnicas y procedimientos establecidos en la UNEpara la investigación de accidentes laborales. In Cuba, like in the rest of the world, the existence of Laws and state Regulations, they force to productivecompanies and services, they have a prevention system to avoid the accidents and professional illnessesthat, starting from the control of the existent risks in each work position, allow working in a sure atmosphere.In this article the techniques and procedures are explained, applied in the Electric Union (UNE, for thelabor accident investigation.

  1. Bupivacaína 0,25% peridural, en la analgesia de parto: efectos hemodinámicos en la madre y feto

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    Silvia Arias

    2006-09-01

    Full Text Available Objetivo: Valorar la bupivacaína 0,25% por catéter epidural en el alivio del dolor de parto y efectos en la hemodinamia materna, progreso del parto y pH neonatal. Diseño: Estudio descriptivo, longitudinal, prospectivo. Lugar: Centro Obstétrico del Instituto Especializado Materno Perinatal, Lima, Perú, hospital de enseñanza universitaria. Pacientes: Sesenta parturientas en fase activa de trabajo de parto. Intervenciones: Se administró a las parturientas bupivacaína 0,25% 12 mL, vía catéter epidural, haciendo control del dolor con la escala visual análoga. Se registró la hemodinamia materno-fetal, pre y postanalgesia, dosis suplementaria de bupivacaína 0,25% 6 mL, trazado cardiotocográfico fetal, complicaciones. Se utilizó el programa estadístico SPSS 13,0. Principales medidas de resultados: Disminución del dolor, hemodinamia materna, pH neonatal. Resultados: La administración de bupivacaína 0,25% disminuyó significativamente el dolor (p < 0,001, prueba de Friedman, requiriendo 33 parturientas analgesia suplementaria (45 mg BPV prom.. La frecuencia basal fetal preanalgesia fue 142 lat/min y postanalgesia, 136 lat/min (t student p < 0,05; el dermatoma alcanzado fue T8, con duración promedio de 115 min; la satisfacción fue excelente en 50,1%. Se usó oxitocina en 88,3% (13,1mU/min, DE 3,2 mU/min, asociándose al acortamiento del tiempo de la fase activa en 2,42 h en primigestas y 1,55 h en multigestas; la cesárea fue necesaria en 11,7%, el PH neonatal promedio 7,24. Conclusiones: La analgesia epidural con bupivacaína 0,25% vía catéter es eficaz. La hemodinamia materna se mantiene, el latido cardiaco fetal desciende 12 latidos/min en promedio, la fase activa se acorta, estando relacionado al requerimiento de oxitocina.

  2. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

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    Luiz Eduardo Imbelloni

    2006-12-01

    dos cinco nervos do plexo lombar.JUSTIFICATIVA Y OBJETIVOS: Este estudio evaluó la eficacia de la inyección única de bupivacaína a 0,25% en el compartimiento del psoas o perivascular inguinal a través del estimulador de nervios periféricos para analgesia postoperatoria en pacientes sometidos a intervenciones quirúrgicas ortopédicas. MÉTODO: Cien pacientes recibieron bloqueo del plexo lumbar a través del compartimiento del psoas y fueron comparados con 100 pacientes que recibieron bloqueo del plexo lumbar vía perivascular inguinal, identificados por el estimulador de nervios periféricos con la inyección de 40 mL bupivacaína a 0,25% sin epinefrina. La analgesia en los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fue evaluada a las 4, 8, 12, 16, 20 y 24 horas después del final de la intervención quirúrgica. La intensidad del dolor también fue medida en el mismo período. La cantidad de opioides administrada en el postoperatorio fue anotada. En cinco pacientes de cada grupo, un estudio radiográfico con contraste no iónico se realizó para medir la dispersión de la solución anestésica. RESULTADOS: Los nervios ilioinguinal, genitofemoral, cutáneo femoral lateral, femoral y obturatorio fueron bloqueados en 92% de los pacientes en el compartimiento del psoas versus 62% en el bloqueo perivascular inguinal. El bloqueo del plexo lumbar redujo la necesidad de opioides y 42% de los pacientes sometidos al bloqueo del compartimiento del psoas y 36% de los pacientes en el bloqueo inguinal no necesitaron analgésico adicional en el postoperatorio. La duración de la analgesia fue de aproximadamente 21 horas con el bloqueo del compartimiento del psoas y 15 horas en el bloqueo perivascular inguinal. CONCLUSIONES: El bloqueo del compartimiento del psoas y perivascular inguinal es una excelente técnica para la analgesia postoperatoria en intervenciones quirúrgicas ortopédicas reduciendo la necesidad de opioides. Ese

  3. Cementos con cenizas volantes

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    Ossa M., Mauricio

    1984-03-01

    additions of 20 and 30% .

    Casi la generalidad de los estudios realizados sobre cementos con adición de cenizas volantes se refieren a sus características y comportamiento en pastas, morteros y hormigones, siempre en relación con aquéllos del cemento portland. Esta vez, se desarrolló un trabajo experimental orientado a relacionar entre sí los cementos con adiciones de cenizas volantes y de puzolana natural. Para ello se fabricaron a escala de laboratorio cementos de ambos tipos, empleando como materias primas comunes clinker y yeso y, como variables, diferentes porcentajes de las dos adiciones, que cumplieron previamente los requisitos normalizados en cuanto a sus actividades puzolánicas. La calidad de los cementos fabricados resultó adecuada y concordante con la del cemento portland-puzolánico obtenido a escala industrial con los mismos clinker, yeso y puzolana natural de este estudio. Posteriormente, se determinaron las características de los cementos experimentales y se confeccionaron morteros normales para la realización de ensayos físicos y mecánicos. Los resultados de ensayos indicaron que los cementos con adición de cenizas volantes (CCV requieren menos agua para consistencia normal, presentan tiempos de fraguado mayores y expansiones en autoclave menores que los cementos con adición de puzolana (CP. Los calores de hidratación a 7 y 28 días de edad fueron aproximadamente similares para ambos tipos de cemento. En morteros normales, los cementos CCV mostraron menor retracción de secado, mayor retentividad y mayor fluidez (para igual cantidad de agua que los cementos CP. En los ensayos de exudación se observó que ésta depende más de la finura que el tipo de adición. Finalmente, los ensayos mecánicos señalaron que las resistencias a compresión y flexotracción de los morteros con cementos CCV son menores a edades inferiores que 14 días (del orden de 5 a 10% a un día de edad, pero que a partir de entonces pasan a ser mayores que las de

  4. competencia con China

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    Elena de la Paz Hernández Águila

    2007-01-01

    Full Text Available El artículo ofrece un diagnóstico del desempeño de la industria mexicana del calzado desde la década de los ochenta hasta la actualidad. Analiza la problemática que ha enfrentado esta rama industrial a partir del proceso de apertura comercial y de la competencia en su mercado interno con productos provenientes de países asiáticos, particularmente China. Problematiza al respecto los retos y las perspectivas que a mediano plazo enfrentará este sector empresarial y sobre las posibilidades de competir en el mercado globalizado.

  5. Construir con Madera

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    Olabe-Velasco, F. (Fermín); Val-Hernández, Y. (Yolanda); Varela-de-la-Cruz, P. (Perla); Cabrero-Ballarín, J.M. (José Manuel)

    2010-01-01

    Guía divulgativa ‘Construir con madera’, elaborada por la Cátedra Madera de la Universidad de Navarra y el Gobierno de Navarra. La publicación pretende explicar de forma sencilla los beneficios y posibilidades de este material en la construcción, tanto en lo que respecta a su resistencia, comportamiento frente al fuego, durabilidad, capacidad de aislamiento, propiedades acústicas, estética, respeto al medio ambiente y sostenibilidad como fuente de energía. A modo de ejemplo, en la ...

  6. Comportamiento y prácticas sexuales de hombres que tienen relaciones sexuales con hombres en el Distrito Federal – Brasil

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    Maria Josenilda Gonçalves da SILVA et al

    2007-11-01

    Full Text Available Objectivo: Describir el comportamiento y las prácticas sexuales de hombres que tienen relaciones sexuales con hombres en el Distrito Federa. Metodología: Estudio transversal con una muestra de conveniencia de 465 hombres con más de 18 años de edad, con comportamiento homosexual, que frecuentaban locales de diversión gay. Fue utilizado un cuestionário estructurado, conteniendo preguntas sobre aspectos socioeconómicos, comportamentales, uso de sustancias tóxicas y violencia. Resultados: Hay una diferencia del predominio de prácticas del sexo seguro y la práctica del sexo oral y anal; la edad más joven es un factor con influencia significativa estadisticamente para el predominio mayor de la práctica del sexo seguro; los tipos de compañeros fijos u ocasionales también influenciam sobre el predominio del uso del condón. Discussión: De acuerdo con otros estudios realizados en capitales brasileñas, hay una variación decreciente de proteción de acuerdo con la edad de los hombres y menor proteción con compañeros fijos; también hay una propensión de subestimar el riesgo de la práctica sexual cuando no hay eyaculación. Estos son algunos puntos que pueden ser enfatizados en abordajens preventivas en salud pública. Conclusiones: Los resultados evidencian que las características de la epidemia del Sida y su dinámica ponen para los servicios de salud nuevos desafíos y la necesidad de um proceso permanente de acompañamiento y valoración de las acciones de prevención efectivamente dirigidas a los segmentos más vulnerables a la infección.

  7. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Background and Aims: Opioids as epidural adjunct to local anesthetics (LA have been in use since long and α-2 agonists are being increasingly used for similar purpose. The present study aims at comparing the hemodynamic, sedative, and analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine. Methods: A total of one hundred patients of both gender aged 21-56 years, American Society of Anaesthesiologist (ASA physical status I and II who underwent lower limb orthopedic surgery were enrolled into the present study. Patients were randomly divided into two groups: Ropivacaine + Dexmedetomidine (RD and Ropivacaine + Fentanyl (RF, comprising 50 patie nts each. Inj. Ropivacaine, 15 ml of 0.75%, was administered epidurally in both the groups with addition of 1 μg/kg of dexmedetomidine in RD group and 1 μg/kg of fentanyl in RF group. Besides cardio-respiratory parameters and sedation scores, various block characteristics were also observed which included time to onset of analgesia at T10, maximum sensory analgesic level, time to complete motor blockade, time to two segmental dermatomal regressions, and time to first rescue analgesic. At the end of study, data was compiled systematically and analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P<0.05 is considered significant and P<0.001 as highly significant. Results: The demographic profile of patients was comparable in both the groups. Onset of sensory analgesia at T10 (7.12±2.44 vs 9.14±2.94 and establishment of complete motor blockade (18.16±4.52 vs 22.98±4.78 was significantly earlier in the RD group. Postoperative analgesia was prolonged significantly in the RD group (366.62±24.42 and consequently low dose consumption of local anaesthetic LA (76.82±14.28 vs 104.35±18.96 during epidural top-ups postoperatively. Sedation scores were much better in the RD group and highly significant on

  8. Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis.

    Science.gov (United States)

    Bonouvrié, Kimberley; van den Bosch, Anouk; Roumen, Frans J M E; van Kuijk, Sander M; Nijhuis, Jan G; Evers, Silvia M A A; Wassen, Martine M L H

    2016-12-01

    To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that

  9. Entrevista con Giovanni Levi

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    Monica Oliveira

    2017-06-01

    Full Text Available En esta entrevista, Giovanni Levi - como un conocedor del tema de Familia - realiza una importante evaluación sobre el actual estado de las investigaciones realizadas en el Brasil y em el exterior. Con estilo franco, agudo y lucido critica las visiones tradicionales y sus ilusiones ypropone nuevos conceptos y métodos. La historia de la familia debería ceder espacio para el estudio de las redes relacionales o de los mundos relacionales. De la misma forma, la historia cuantitativa debería abrir espacio para el estudio de las cualidades. Ya con relación a la historia de las elites, tan estudiada y reproducida en una diversidad de trabajos, que deberíase mirar en otra perspectiva. Es decir, no mirar a las reglas sociales predeterminadas, sino a los desvíos y a las variaciones. Levi defiende que los historiadores deben trascender a los documentos que se encuentran fácilmente y que pueden fortalecer perspectivas deformadas y esequilibradas de la sociedad. Para él, los historiadores deben esforzarse por estudiar a aquellos grupos que dejaron pocos rastros documentales. En ese esfuerzo existiría una nueva mirada sobre la historia de la familia.

  10. Entrevista con Patricia Ariza

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    Esperanza Londoño La Rotta

    2017-01-01

    Full Text Available Pensamiento, Palabra y Obra entrevista a una artista, feminista y activista política, quien como mujer y artista ha permitido pensar el arte más allá de un simple espectáculo. Toda una vida dedicada al teatro y a darle voz, a través de sus obras, a víctimas del conflicto colombiano, defensora de derechos humanos; además de hacer evidente en su vida y a través de la plataforma “Artistas por la paz”, las múltiples relaciones que se pueden establecer entre el arte, la construcción de paz y la resolución de conflictos. Hablamos en su casa, en medio del calor de la bienvenida con Patricia Ariza, directora del festival alternativo de teatro, de Mujeres en Escena y de la Corporación Colombiana de Teatro, entre otras muchas actividades que voluntariamente su espíritu libertario ha asumido. Esta entrevista se realizó antes del 2 de octubre, pero con la revisión de los acuerdos que propició el plebiscito ganado por una ínfima minoría por el no, sigue siendo vigente este planteamiento.

  11. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

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    Hala Mostafa Gomaa

    2014-10-01

    Conclusion: Either intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

  12. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

    NARCIS (Netherlands)

    Hinkelbein, Jochen; Lamperti, Massimo; Akeson, Jonas; Santos, Joao; Costa, Joao; De Robertis, Edoardo; Longrois, Dan; Novak-Jankovic, Vesna; Petrini, Flavia; Struys, Michel M. R. F.; Veyckemans, Francis; Fuchs-Buder, Thomas; Fitzgerald, Robert

    2018-01-01

    Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures. The role of, and credentialing required by, anaesthesiologists and practitioners performing PSA has been

  13. Dexmedetomidine improves intraoperative conditions and quality of postoperative analgesia when added to epidural in elective cesarean section

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    Samy Elsayed Hanoura

    2014-10-01

    Conclusion: Adding dexmedetomidine to regular mixture of epidural anesthetics in women undergoing elective cesarean section improved intraoperative conditions and quality of postoperative analgesia without maternal or neonatal significant side effects.

  14. Analgesia obstétrica farmacológica: um estudo sobre os desfechos obstétricos e neonatais

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    Ruanna Lorna Vieira Fernandes

    2017-01-01

    Full Text Available Objective: to investigate the association between pharmacological obstetric analgesia and obstetric and neonatal outcomes. Methods: it was a retrospective case-control study conducted with 393 pregnant women comprising 131 cases of pharmacological obstetric analgesia and 262 controls that did not perform this procedure. The sociodemographic and obstetric profile, the circumstances of parturient admission, obstetrical decisions, and obstetric and neonatal outcomes were investigated. Results: pregnant women submitted to pharmacological analgesia during labor presented an increased risk for the use of exogenous oxytocin (p<0.001, episiotomy (p=0.001, Kristeller maneuver (p=0.036, and forceps (p=0.004. Conclusion: pharmacological analgesia does not increase the risk of spontaneous perineal tear, abdominal delivery, and hospitalization in neonatal unit. Nevertheless, it influences the increased risk of synthetic oxytocin use, Kristeller maneuver, episiotomy, forceps, and the occurrence of lower first-minute Apgar scores.

  15. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

    Directory of Open Access Journals (Sweden)

    Monica Rossi Rodrigues

    2009-12-01

    con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección de PJC en niños. MÉTODO: Estudio randómico doble ciego, en niños sometidos a la intervención quirúrgica para liberación posteromedial de PJC, ubicadas en cuatro grupos conforme a la técnica anestésica: caudal (ACa; bloqueos isquiático y femoral (IF; bloqueos isquiático y safeno (IS; bloqueo isquiático y anestesia local (IL, asociados a la anestesia general. En las primeras 24 horas, los pacientes recibieron dipirona y paracetamol vía oral y fueron evaluados por un anestesiólogo que no conocía la técnica usada. Conforme a las puntuaciones de la escala CHIPPS (Children's and infants postoperative pain scale, se administraba morfina vía oral (0,19 mg.kg-1 por día. RESULTADOS: Fueron estudiados 118 niños distribuidos en los grupos ACa (30, IF (32, IS (28 IL (28. El tiempo promedio entre el bloqueo y la primera dosis de morfina fue de 6,16 horas en el grupo ACa, 7,05 horas en el IF, 7,58 horas en el IS y 8,18 horas en el IL. El consumo de morfina fue de 0,3 mg.kg-1 por día en los cuatro grupos. No hubo diferencia significativa entre los grupos. CONCLUSIONES: Los bloqueos nerviosos periféricos no promovieron un tiempo más elevado de analgesia, ni tampoco una reducción en el consumo de morfina en las primeras 24 horas, en niños sometidos a la corrección de PJC cuando se les comparó con el bloqueo epidural caudal.BACKGROUND AND OBJECTIVES: Correction of congenital clubfoot (CCF is associated with

  16. Evaluation of Pain Assessment Techniques and Analgesia Efficacy in a Female Guinea Pig (Cavia porcellus) Model of Surgical Pain

    Science.gov (United States)

    Oliver, Vanessa L; Athavale, Stephanie; Simon, Katherine E; Kendall, Lon V; Nemzek, Jean A; Lofgren, Jennifer L

    2017-01-01

    Guinea pigs (Cavia porcellus) are a frequently used species in research, often involving potentially painful procedures. Therefore, evidence-based recommendations regarding analgesia are critically needed to optimize their wellbeing. Our laboratory examined the efficacy of carprofen and extended-release (ER) buprenorphine, alone and as a multimodal combination, for relieving postsurgical pain in guinea pigs. Animals were assessed by using evoked (mechanical hypersensitivity), nonevoked (video ethogram, cageside ethogram, time-to-consumption test), and clinical (weight loss) measurements for 96 h during baseline, anesthesia–analgesia, and hysterectomy conditions. In addition, ER buprenorphine was evaluated pharmacologically. Guinea pigs treated with a single analgesic showed increased mechanical sensitivity for at least 96 h and indices of pain according to the video ethogram for as long as 8 h, compared with levels recorded during anesthesia–analgesia. In contrast, animals given both analgesics demonstrated increased mechanical sensitivity and behavioral evidence of pain for only 2 h after surgery compared with anesthesia–analgesia. The cageside ethogram and time-to-consumption tests failed to identify differences between conditions or treatment groups, highlighting the difficulty of identifying pain in guinea pigs without remote observation. Guinea pigs treated with multimodal analgesia or ER buprenorphine lost at least 10% of their baseline weights, whereas weight loss in carprofen animals was significantly lower (3%). Plasma levels for ER buprenorphine exceeded 0.9 ng/mL from 8 to 96 h after injection. Of the 3 analgesia regimens evaluated, multimodal analgesia provided the most effective pain control in guinea pigs. However the weight loss in the ER buprenorphine–treated animals may need to be considered during analgesia selection. PMID:28724492

  17. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

    Science.gov (United States)

    Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

    2014-05-01

    We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  18. The effect of addition of dexamethasone to levobupivacaine in parturients receiving combined spinal-epidural for analgesia for vaginal delivery

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    Amr Samir Wahdan

    2017-01-01

    Full Text Available Background and Aims: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. Methods: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Forty females were included randomly in either Group L (received intrathecal levobupivacaine 0.25% in 2 mL or Group LD (received intrathecal levobupivacaine 0.25% combined with dexamethasone 4 mg in 2 mL. The primary outcome was the duration of spinal analgesia. Secondary outcomes included the total dose of epidural local anaesthetic given, time to delivery, neonatal outcome and adverse effects. Results: The duration of spinal analgesia was significantly longer in the LD group compared with L group (80.5 ± 12.4 min vs. 57.1 ± 11.5 min, respectively; P< 0.001. In Group LD compared with Group L, time from spinal analgesia to delivery was significantly lower (317.4 ± 98.9 min vs. 372.4 ± 118.8 min, respectively; P = 0.027, and total epidural levobupivacaine consumption was significantly lower (102.4 ± 34.8 mg vs. 120.1 ± 41.9 mg, respectively; P = 0.027. The two groups were comparable with respect to characteristics of sensory and motor block, haemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects. Conclusion: Intrathecal dexamethasone plus levobupivacaine prolongs the duration of spinal analgesia during combined spinal-epidural CSE for labour analgesia.

  19. The effects of preoperative oral administration of carprofen or tramadol on postoperative analgesia in dogs undergoing cutaneous tumor removal.

    Science.gov (United States)

    Karrasch, Nicole M; Lerche, Phillip; Aarnes, Turi K; Gardner, Heather L; London, Cheryl A

    2015-08-01

    This prospective, blinded, controlled clinical study compared the effects of pre-emptive oral administration of carprofen or tramadol on pain scores and analgesic requirement in dogs undergoing cutaneous tumor removal. Thirty-six client-owned dogs presenting for cutaneous tumor removal were randomly assigned to receive carprofen, tramadol, or no treatment prior to surgery. Pain was assessed using a visual analog scale (VAS), the Modified Glasgow Composite Measure Pain Score (MGCMPS), and algometry at enrollment, prior to premedication, at extubation, then hourly for the first 4 h, and every 4 h for 24 h. Dogs scoring ≥ 7 (MGCMPS), or having a VAS measurement ≥ 40 mm were given rescue analgesia. There were no significant differences in pain VAS, MGCMPS, or algometry. There were no differences in rescue analgesia requirement, or time to rescue analgesia among groups. Carprofen, tramadol, or no pre-emptive analgesia, combined with pre-operative hydromorphone and rescue analgesia, resulted in satisfactory analgesia in the 24-hour postoperative period.

  20. [Effect of nonsteroidal anti-inflammatory drugs and paracetamol on hemodynamic changes during postoperative analgesia in children].

    Science.gov (United States)

    Leont'ev, D V; Babaev, B D; Shishkov, M V; Ostreĭkov, I F

    2005-01-01

    The purpose of the present study was to comparatively assess the adequacy of postoperative analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol in children undergone "minor" surgical interventions. For postoperative analgesia in children, the authors used paracetamol in a single dose of 25-30 mg/kg, diclofenac in a dose of 1.5-2.0 mg/kg, which were rectally administered as suppositories, as well as diclofenac in the same dose as intramuscular injections (Group 1). A comparison was made with postoperative analgesia using analgin and promedole (Group 2 (control)). Group 1 comprised 63 patients and Group 2 included 26 patients with identical diseases (inguinal hernias, varicocele, phimosis). Functional parameters were recorded in patients in the lying position before, 30 min, 1, 2, and 3 hours after surgery. The efficiency of postoperative analgesia was evaluated, by using central hemodynamic parameters that many investigators consider to be one of the major criteria for the adequacy of anesthesia. Comparison of postoperative data has revealed a difference between the groups, which suggests that the use of NSAIDs and paracetamol for preventive and postoperative analgesia in children substantially improves the postoperative period and promotes a rapid rehabilitation in patients. Comparative analysis of the efficiency of postoperative analgesia of the above agents has indicated that diclofenac and paracetamol have a sufficient analgesic activity and at the same time do not show the adverse reactions unique to narcotic analgesics.

  1. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

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    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  2. Impact of epidural analgesia on cesarean and operative vaginal delivery rates classified by the Ten Groups Classification System.

    Science.gov (United States)

    Lucovnik, M; Blajic, I; Verdenik, I; Mirkovic, T; Stopar Pintaric, T

    2018-05-01

    The Ten Group Classification System (TGCS) allows critical analysis according to the obstetric characteristics of women in labor: singleton or multiple pregnancy, nulliparous, multiparous, or multiparous with a previous cesarean delivery, cephalic, breech presentation or other malpresentation, spontaneous or induced labor, and term or preterm births. Labor outcomes associated with epidural analgesia may be different among the different labor classification groups. The aim of this study was to explore associations between epidural analgesia and cesarean delivery, and epidural analgesia and assisted vaginal delivery, in women classified using the TGCS. Slovenian National Perinatal Information System data for the period 2007-2014 were analyzed. All women after spontaneous onset or induction of labor were classified according to the TGCS, within which cesarean and vaginal assisted delivery rates were investigated (P cesarean delivery rates. Women in group 1 (nulliparous term women with singleton fetuses in cephalic presentation in spontaneous labor) with epidural analgesia had a higher cesarean delivery rate. In most TGCS groups women with epidural analgesia had higher assisted vaginal delivery rates. Epidural analgesia is associated with different effects on cesarean delivery and assisted vaginal delivery rates in different TGCS groups. Copyright © 2018. Published by Elsevier Ltd.

  3. Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation

    DEFF Research Database (Denmark)

    Møiniche, S; Bülow, Steffen; Hesselfeldt, Peter

    1995-01-01

    OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17...... unselected patients (median age 69 years) undergoing colonic resection. INTERVENTIONS: Patients received combined epidural and general anaesthesia during operations and after operation were given continuous epidural bupivacaine 0.25%, 4 ml hour and morphine 0.2 mg hour, for 96 hours and oral paracetamol 4 g...... weight loss. CONCLUSION: These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations....

  4. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

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    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  5. Bacterial infection in deep paraspinal muscles in a parturient following epidural analgesia.

    Science.gov (United States)

    Yang, Ying-Wei; Chen, Wei-Ting; Chen, Jui-Yuan; Lee, She-Chin; Chang, Yi; Wen, Yeong-Ray

    2011-06-01

    We report a case of paraspinal muscle infection shortly after epidural analgesia for labor pain in a nulliparous parturient who was subjected to emergent Cesarean section because of fetal distress. Epidural morphine was administered for 3 days for postoperative pain control. She began to have constant lower back pain on postpartum Day 4. Magnetic resonance image study revealed a broad area of subcutaneous edema with a continuum along the catheter trajectory deep to the paraspinal muscles. An injection-related bacterial infection was suspected; the patient was treated with intravenous antibiotics and was soon cured uncomplicatedly. Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. We herein report a case complicated by iatrogenic infection, discuss the causes, and give suggestions for prevention. Copyright © 2011. Published by Elsevier B.V.

  6. Ultrasound investigation central hemodynamics as a method of assessment effective analgesia in children

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    K. Y. Dmytriieva

    2016-06-01

    Vinnitsa National Medical University M.I. Pirogov   Summary: The study was include in 23 children (12,4±1,2 years operated on for tumors of the retroperitoneal space (14 children, 61%, renal tumors (6 children, 26%, ovarian cancer (3 children, 13% showed that a comprehensive study of the reactions of pain behavior and central hemodynamics by ultrasonography showed that the use of the scheme KSME bupivacaine 0.3-0.4 mg / kg and a continuous infusion of drugs (fentanyl in a dose of 10 mcg/kg/h for postoperative pain relief leads to effective analgesia after traumatic operations and comprehensive ultrasound including color and spectral Doppler studies, is the main tool by enabling timely and accurately assess the condition of the central hemodynamics at different methods of analgesia.   Key words: central hemodynamics, ultrasound, anesthesia.

  7. Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings.

    Science.gov (United States)

    Linnman, Clas; Catana, Ciprian; Petkov, Mike P; Chonde, Daniel Burje; Becerra, Lino; Hooker, Jacob; Borsook, David

    2018-01-01

    Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9) and matched healthy controls (n = 9) using 11 C-diprenoprhine Positron Emission Tomography (PET) and simultaneous functional Magnetic Resonance Imaging (fMRI). Intravenous saline injections (the placebo) led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.

  8. Molecular and functional PET-fMRI measures of placebo analgesia in episodic migraine: Preliminary findings

    Directory of Open Access Journals (Sweden)

    Clas Linnman

    2018-01-01

    Full Text Available Pain interventions with no active ingredient, placebo, are sometimes effective in treating chronic pain conditions. Prior studies on the neurobiological underpinnings of placebo analgesia indicate endogenous opioid release and changes in brain responses and functional connectivity during pain anticipation and pain experience in healthy subjects. Here, we investigated placebo analgesia in healthy subjects and in interictal migraine patients (n = 9 and matched healthy controls (n = 9 using 11C-diprenoprhine Positron Emission Tomography (PET and simultaneous functional Magnetic Resonance Imaging (fMRI. Intravenous saline injections (the placebo led to lower pain ratings, but we did not find evidence for an altered placebo response in interictal migraine subjects as compared to healthy subjects.

  9. [Prediction of intra-abdominal hypertension risk in patients with acute colonic obstruction under epidural analgesia].

    Science.gov (United States)

    Stakanov, A V; Potseluev, E A; Musaeva, T S

    2013-01-01

    Purpose of the study was to identify prediction possibility of direct current potential level for intra-abdominal hypertension risk in patients with acute colonic obstruction under preoperative epidural analgesia. Prospective analysis of the preoperative period was carried out in 140 patients with acute colonic obstruction caused by colon cancer. Relations between preoperative level of permanent capacity and risk of intra-abdominal hypertension was identified Direct current potential level is an independent predictor of intra-abdominal hypertension. Diagnostic significance increases from first to fifth hour of preoperative period according to AUROC data from 0.821 to 0.905 and calibration 6.9 (p > 0.37) and 4.7 (p > 0.54) by Hosmer-Lemeshou criteria. The use of epidural analgesia in the complex intensive preoperative preparation is pathogenically justified. It reduces intra-abdominal hypertension in patients with acute colonic obstruction.

  10. Patient-controlled analgesia with remifentanil vs. alternative parenteral methods for pain management in labour

    DEFF Research Database (Denmark)

    Jelting, Y; Weibel, S; Afshari, A

    2017-01-01

    events for mothers and newborns. We assessed risk of bias for each included study and applied the GRADE approach for the quality of evidence. We included total zero event trials, using a constant continuity correction of 0.01 and a random-effect meta-analysis. Twenty studies were included...... opioids (four trials, 216 patients, very low quality evidence) with a standardised mean difference ([SMD] 95%CI) of 2.11 (0.72-3.49), but were less satisfied than women receiving epidural analgesia (seven trials, 2135 patients, very low quality evidence), -0.22 (-0.40 to -0.04). Data on adverse events......, 135 patients, low-quality evidence) no conclusion could be reached as all study arms showed zero events. The relative risk (95%CI) of Apgar scores less than 7 at 5 min after birth compared with epidural analgesia (five trials, 1322 participants, low-quality evidence) was 1.26 (0.62-2.57)....

  11. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...... of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48 h......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  12. Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

    DEFF Research Database (Denmark)

    Stjernström, H; Henneberg, S; Eklund, A

    1985-01-01

    of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines...... anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection...... increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age....

  13. A Bayesian perspective on sensory and cognitive integration in pain perception and placebo analgesia.

    Directory of Open Access Journals (Sweden)

    Davide Anchisi

    Full Text Available The placebo effect is a component of any response to a treatment (effective or inert, but we still ignore why it exists. We propose that placebo analgesia is a facet of pain perception, others being the modulating effects of emotions, cognition and past experience, and we suggest that a computational understanding of pain may provide a unifying explanation of these phenomena. Here we show how Bayesian decision theory can account for such features and we describe a model of pain that we tested against experimental data. Our model not only agrees with placebo analgesia, but also predicts that learning can affect pain perception in other unexpected ways, which experimental evidence supports. Finally, the model can also reflect the strategies used by pain perception, showing that modulation by disparate factors is intrinsic to the pain process.

  14. Factores de riesgo para padecer trastornos psicóticos: ¿Es posible realizar una detección preventiva?

    Directory of Open Access Journals (Sweden)

    Jorge L. Tizón

    2008-01-01

    Full Text Available Introducción: Revisión de los factores de riesgo para las psicosis desde la perspectiva de la literatura internacional y desde la perspectiva de la experiencia clínica e investigadora del equipo. Objetivo principal: Se presenta el diseño y las primeras pruebas de un instrumento de exploración y cribaje de señales de alarma y factores de riesgo de trastornos mentales severos, y en especial trastornos psicóticos, aplicable en los primeros años de vida por parte de los servicios de atención primaria de salud y los equipamientos de salud mental vinculados con ellos. Se trata del LISMEN (Listado de ítems de Salud Mental en edades preescolares y escolares. Metodología: 5 muestras diferentes, tanto de edad infantil como de adultos. El trabajo se centra en la muestra A del Proyecto LISMEN: Se trata de un estudio descriptivo retrospectivo de los dossieres de los pacientes que han desarrollado una psicosis (N=838 y se habían visitado previamente, ya durante la infancia, en la misma Unidad de Salud Mental (N=120. Resultados: Se utilizan los resultados de las muestras anteriormente estudiadas para encuadrar el tema y presentar los primeros resultados de la muestra A: Estos señalan una constelación de factores de riesgo que aparecen ya en las historias o dossiers clínicos de la infancia de los pacientes que van a desarrollar una psicosis postpuberal. Conclusiones: Aunque hoy poseemos un amplio acervo de conocimientos sobre factores de riesgo de la esquizofrenia y otras psicosis, eso no implica que podamos predecir el trastorno en base a los mismos. El LISMEN es un intento en ese sentido.

  15. Enfermedad por meningococo, Neisseria meningitidis: perspectiva epidemiológica, clínica y preventiva Meningococcal disease caused by Neisseria meningitidis: epidemiological, clinical, and preventive perspectives

    Directory of Open Access Journals (Sweden)

    Lourdes Almeida-González

    2004-10-01

    Full Text Available La meningitis bacteriana continúa siendo uno de los grandes problemas de la salud pública mundial. En particular, la infección por Neisseria meningitidis afecta tanto a países desarrollados como subdesarrollados, y se presenta en formas endémicas y epidémicas. La enfermedad meningocóccica se puede manifestar clínicamente no sólo como meningitis, sino con cuadros fulminantes de meningococcemia. La persistencia de N. meningitidis se debe al gran porcentaje de portadores y a la dinámica de transmisión de la bacteria. Aproximadamente 500 millones de personas en el mundo son portadoras de N. meningitidis en la nasofaringe. Los factores de transmisiblidad identificados han sido el tabaquismo activo o pasivo, la presencia de infecciones virales del tracto respiratorio superior, épocas de sequía, y el hacinamiento. Por lo anterior, se han descrito brotes de enfermedad meningocóccica en cuarteles militares, escuelas, cárceles y dormitorios. Algunos determinantes que permiten la invasión sistémica incluyen daños en la mucosa nasofaríngea de portadores, cepas virulentas con formación de cápsula, ausencia de anticuerpos bactericidas y deficiencias del sistema del complemento. El control de la enfermedad meningocóccica en circunstancias endémicas y epidémicas se logra por el tratamiento de casos con antibióticos adecuados (penicilina, ceftriaxona o cloranfenicol, la quimioprofilaxis de contactos cercanos (ciprofloxacina, rifampicina o ceftriaxona, y la vigilancia clínica de éstos. Sin embargo, es fundamental subrayar que la clave para el control efectivo de la enfermedad meningocóccica es la inmunoprofilaxis. Las vacunas disponibles incluyen las de polisacáridos monovalentes o bivalentes (serogrupos A y C, tetravalentes (A, C, Y, W-135, la conjugada (C o la combinada de proteínas de membrana celular y polisacárido (B y C. Recientemente nos hemos visto forzados a establecer planes nacionales de respuesta que incluyen la

  16. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

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    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  17. Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain?

    OpenAIRE

    Mathews, Timothy J.; Churchhouse, Antonia M.D.; Housden, Tessa; Dunning, Joel

    2011-01-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘is the addition of ketamine to morphine patient-controlled analgesia (PCA) following thoracic surgery superior to morphine alone’. Altogether 201 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and...

  18. Safety and Efficacy of a Pharmacist-Managed Patient-Controlled Analgesia Service in Postsurgical Patients.

    Science.gov (United States)

    McGonigal, Katrina H; Giuliano, Christopher A; Hurren, Jeff

    2017-09-01

    To compare the safety and efficacy of a pharmacist-managed patient-controlled analgesia (PCA) service with physician/midlevel provider-managed (standard) PCA services in postsurgical patients. This was a multicenter, retrospective cohort study performed at 3 major hospitals in the Detroit, Michigan, metropolitan area. Postsurgical patients from October 2012 to December 2013 were included. The primary outcome compared the pain area under the curve adjusted for time on PCA (AUC/T) of patients receiving pharmacist-managed PCA services vs. standard care, up to 72 hours after initiation of PCA. Secondary outcomes included initial opioid selection, programmed PCA settings, duration of PCA use, frequency of adjunct analgesia utilization, and frequency of breakthrough analgesia utilization. Safety outcomes were assessed as a composite safety endpoint and individually. Total pain AUC/T scores did not differ between the pharmacist-managed and standard-managed groups (3.25 vs. 3.25, respectively; P = 0.98). Adjunct pain medications were given with similar frequency in the 2 groups; however, significantly fewer patients required breakthrough pain medication in the pharmacist-managed group (11% vs. 36%, respectively; P patients requiring antiemetic use (46% vs. 32%; P = 0.04). A pharmacist-managed PCA service provided no difference in pain control compared to standard management. The requirement for breakthrough analgesia was decreased in the pharmacist group, while the need for antiemetic use was increased. Further research should be conducted to evaluate different PCA management strategies. © 2016 World Institute of Pain.

  19. Epidural Labor Analgesia-Fentanyl Dose and Breastfeeding Success: A Randomized Clinical Trial.

    Science.gov (United States)

    Lee, Amy I; McCarthy, Robert J; Toledo, Paloma; Jones, Mary Jane; White, Nancy; Wong, Cynthia A

    2017-10-01

    Breastfeeding is an important public health concern. High cumulative doses of epidural fentanyl administered for labor analgesia have been reported to be associated with early termination of breastfeeding. We tested the hypothesis that breastfeeding success is adversely influenced by the cumulative epidural fentanyl dose administered for labor analgesia. The study was a randomized, double-blind, controlled trial of parous women at greater than 38 weeks gestation who planned to breastfeed, had successfully breastfed a prior infant, and who received neuraxial labor analgesia. Participants were randomized to receive one of three epidural maintenance solutions for labor analgesia (bupivacaine 1 mg/ml, bupivacaine 0.8 mg/ml with fentanyl 1 μg/ml, or bupivacaine 0.625 mg/ml with fentanyl 2 μg/ml). The primary outcome was the proportion of women breastfeeding at 6 weeks postpartum. Maternal and umbilical venous blood fentanyl and bupivacaine concentration at delivery were measured. A total of 345 women were randomized and 305 had complete data for analysis. The frequency of breastfeeding at 6 weeks was 97, 98, and 94% in the groups receiving epidural fentanyl 0, 1, and 2 μg/ml, respectively (P = 0.34). The cumulative fentanyl dose (difference: 37 μg [95% CI of the difference, -58 to 79 μg], P = 0.28) and maternal and umbilical cord venous fentanyl and bupivacaine concentrations did not differ between women who discontinued breastfeeding and those who were still breastfeeding at 6 weeks postpartum. Labor epidural solutions containing fentanyl concentrations as high as 2 μg/ml do not appear to influence breastfeeding rates at 6 weeks postpartum.

  20. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  1. Alterations in thoracolumbosacral movement when pain causing lameness has been improved by diagnostic analgesia.

    Science.gov (United States)

    Greve, L; Dyson, S; Pfau, T

    2017-06-01

    Lameness, thoracolumbosacral pain and reduced range of motion (ROM) often coexist; better understanding of their relationship is needed. The objectives were to determine if thoracolumbosacral movement of horses changes when pain causing lameness is improved by diagnostic analgesia. We hypothesised that reduction of lameness will increase ROM of the thoracolumbosacral region. Thirteen horses with different types of hind limb lameness were trotted in straight lines and lunged on a 10m diameter circle on left and right reins before and after lameness was subjectively substantially improved by diagnostic analgesia. Inertial sensor data were collected from the withers, thirteenth (T13) and eighteenth thoracic (T18) vertebrae, third lumbar (L3) vertebra, tubera sacrale (TS), left and right tubera coxae. ROM of flexion-extension, axial rotation, lateral bending, dorsoventral, lateral-lateral motion and vertical movement symmetry were quantified at each thoracolumbar site. Hiphike difference (HHD), maximum difference (MaxDiff) and minimum difference (MinDiff) for the pelvic sensors were measured. Percentage changes for before and after diagnostic analgesia were calculated; mean±standard deviation (SD) or median [interquartile range] were determined. Associations between the change in pelvic versus thoracolumbar movement symmetry after each local analgesic technique were tested. After resolution of lameness, HHD decreased by 7% [68%] (P=0.006). The MinDiff decreased significantly by 33% [61%] (P=0.01), 45±13% (P=0.005) and 52±23% (P=0.04), for TS, L3 and T18, respectively. There was significantly increased ROM in flexion-extension at T13, in axial rotation at T13, T18, L3 and in lateral-lateral ROM at L3. Thoracolumbosacral asymmetry and reduced ROM associated with lameness were both altered immediately by improvement in lameness using diagnostic analgesia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

    Directory of Open Access Journals (Sweden)

    A. L. M. J. van der Knijff-van Dortmont

    2016-01-01

    Full Text Available SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

  3. Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy.

    Science.gov (United States)

    Oksar, Menekse; Koyuncu, Onur; Turhanoglu, Selim; Temiz, Muhyittin; Oran, Mustafa Cemil

    2016-11-01

    To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. A prospective, randomized, double-blinded clinical study. Operating room, postoperative recovery area, and ward. In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Continous wound infusion versus epidural postoperative analgesia after liver resection in carcinoma patients

    OpenAIRE

    ŠTEFANČIĆ, LJILJA; BROZOVIĆ, GORDANA; ŠTURM, DEANA; MALDINI, BRANKA; ŠAKIĆ ZDRAVČEVIĆ, KATA

    2013-01-01

    Background: Continuous wound infiltration (CWI) and epidural thoracic analgesia (ETA) are analgesic techniques commonly used in the multimodal management of postoperative pain after open abdominal surgery. The aim of this study was to evaluate the effectiveness in pain reduce and postoperative recovery of these techniques in patients scheduled for liver resection. Methods: The retrospective study included 29 patients, with liver resection performed due to metastases of colon carc...

  5. Intrathecal tramadol as and adjuvant in subrachnoid block to prolong the duration of analgesia

    International Nuclear Information System (INIS)

    Zahid, F.; Tarar, H. M.; Tariq, M.; Nazir, H.; Zafar, I.; Munir, S.

    2017-01-01

    Objective: To assess the effect of intrathecal tramadol added to bupivacaine to prolong the duration of analgesia in subarachnoid block for lower limb orthopedic surgeries. Study Design: Randomized controlled trial. Place and Duration of Study: Anesthesia department of Combined Military Hospital Sialkot, from Nov 2015 to Apr 2016. Material and Methods: Patients were selected by non-probability consecutive sampling. One hundred and fifty patients from American Society of Anesthesiologists (ASA) I, II and III category fulfilling inclusion criteria undergoing various lower limb orthopedic surgeries were divided into two groups by lottery system. Group tramadol bupivacaine (TB) received 25mg (1 ml) of tramadol plus 2ml (10mg) of 0.5 percent bupivacaine while group bupivacaine alone (SB) received 1 ml normal saline plus 2ml (10mg) of 0.5 percent bupivacaine. Time to first analgesia request was noted as a measure of duration of analgesia. Time of onset of sensory block level and peak sensory block level and time to reach the peak sensory block level were also noted. Quality of anesthesia was compared among two groups. Data were analyzed by using SPSS version 22. Results: Four patients were excluded from the study. The duration of anesthesia was effectively prolonged in group TB 181.56 ± 12.42 mins as compared to group SB 120.93 ± 15.54 mins. VAS score was significantly lower in group TB. Higher peak sensory block levels (T6) were achieved in group TB as compared to group SB. However time to reach the peak sensory block levels were significantly longer in group TB. (4.5 ± 0.47mins vs 3.09 ± 0.54 mins). Conclusion: This study showed that intrathecal tramadol (25mg) can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia and improve the quality of anesthesia as well. (author)

  6. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

    Directory of Open Access Journals (Sweden)

    Sukhen Samanta

    2016-01-01

    Full Text Available Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001 regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

  7. Effect of local anaesthesia and/or analgesia on pain responses induced by piglet castration

    Directory of Open Access Journals (Sweden)

    Nyman Görel

    2011-05-01

    Full Text Available Abstract Background Surgical castration in male piglets is painful and methods that reduce this pain are requested. This study evaluated the effect of local anaesthesia and analgesia on vocal, physiological and behavioural responses during and after castration. A second purpose was to evaluate if herdsmen can effectively administer anaesthesia. Methods Four male piglets in each of 141 litters in five herds were randomly assigned to one of four treatments: castration without local anaesthesia or analgesia (C, controls, analgesia (M, meloxicam, local anaesthesia (L, lidocaine, or both local anaesthesia and analgesia (LM. Lidocaine (L, LM was injected at least three minutes before castration and meloxicam (M, LM was injected after castration. During castration, vocalisation was measured and resistance movements judged. Behaviour observations were carried out on the castration day and the following day. The day after castration, castration wounds were ranked, ear and skin temperature was measured, and blood samples were collected for analysis of acute phase protein Serum Amyloid A concentration (SAA. Piglets were weighed on the castration day and at three weeks of age. Sickness treatments and mortality were recorded until three weeks of age. Results Piglets castrated with lidocaine produced calls with lower intensity (p p p = 0.06, n.s. and the following day (p = 0.02. Controls had less swollen wounds compared to piglets assigned to treatments M, L and LM (p p = 0.005; p = 0.05 for C + L compared to M + LM. Ear temperature was higher (p Conclusions The study concludes that lidocaine reduced pain during castration and that meloxicam reduced pain after castration. The study also concludes that the herdsmen were able to administer local anaesthesia effectively.

  8. Capnography monitoring during procedural sedation and analgesia: a systematic review protocol

    OpenAIRE

    Conway, Aaron; Douglas, Clint; Sutherland, Joanna

    2015-01-01

    Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inade...

  9. Anestesthesiological approach to pediatric patient for lobectomy due to lung abscess: Lung separation and epidural analgesia (lung separation and epidural analgesia

    Directory of Open Access Journals (Sweden)

    Vranić Lana

    2017-01-01

    Full Text Available Introduction: Acute lymphoblastic leukemia is the most common malignancy in childhood. Main characteristics of the disease are fast proliferation of lymphoblastic cells in bone marrow, destruction of other cells, causing insufficiency in the bone marow and infiltration of the liver, spleen and the lymphatic nodes. Pulmonary abscess and necrotizing pneumonia are rarely found in pediatric population and usually represent a significant problem for treatment. These conditions often require some surgical treatment modalities. The main goal of anesthesiological approach is to provide good and safe perioperative conditions and adequate analgesia. Case report: During treatment of acute leukemia in a 15-year-old boy, complication inform absenting pneumonia left side lung was developed. After four months antibiotic and antifungal therapy wide broad,(nije jasno decision of consilium was to perform left inferior lobectomy. Antibiotic prophylaxis with Ceftazidime 50 mg/kg BM. We performed a combination of general anesthesia and thoracic epidural anesthesia. Intubation with Robertshaw double lume tube. Ultrasound guided central venous catheter in left jugular veine and arterial line in right radial arteria. Anesthesia depth was controlled with entropy method. Epidural catheter was intoduded on level Thl0-Th 11. Conclusion: One ventilation with double lumen tube prevents spillage of infection sputum into the healthy lung. Epidural analgesia in this clinical situation held numerous benefits especially as a way to reduce postoperative respiratory complications caused by acute pain.

  10. [Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block].

    Science.gov (United States)

    del Fresno Cañiaveras, J; Campos, A; Galiana, M; Navarro-Martínez, J A; Company, R

    2008-11-01

    To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

  11. Central neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.

    Science.gov (United States)

    Caranza, R; Jeyapalan, I; Buggy, D J

    1999-04-01

    In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). The incidence of nausea or vomiting was significantly higher in SM than ED (73% vs. 41%, P=0.01). In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.

  12. Ilioinguinal-iliohypogastric nerve block with intravenous dexketoprofen improves postoperative analgesia in abdominal hysterectomies.

    Science.gov (United States)

    Yucel, Evren; Kol, Iclal Ozdemir; Duger, Cevdet; Kaygusuz, Kenan; Gursoy, Sinan; Mimaroglu, Caner

    2013-01-01

    In this study, our aim was to evaluate the effects of intravenous dexketoprofen trometamol with ilioinguinal and iliohypogastric nerve block on analgesic quality and morphine consumption after total abdominal hysterectomy operations. We conducted this randomized controlled clinical study on 61 patients. The study was conducted in the operation room, post-anesthesia care unit, and inpatient clinic. We randomly grouped the 61 patients into control group (group C), block group (group B) and dexketoprofen-block group (group DB). Before the skin incision performed after anesthesia induction, we performed ilioinguinal iliohypogastric block (group C given saline and group P and DB given levobupivacaine). In contrast to group C and B, group DB was given dexketoprofen. We administered morphine analgesia to all patients by patient-controlled analgesia (PCA) during the postoperative 24 hours. We recorded Visual Analogue Scale (VAS), satisfaction scores, morphine consumption and side effects during postoperative 24 hours. We found the DB group's VAS scores to be lower than the control group and block group's (p dexketoprofen increases patient satisfaction by decreasing opioid consumption, increasing patient satisfaction, which suggests that dexketoprofen trometamol is an effective non-steroidal anti-inflammatory analgesic in postoperative analgesia. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

    BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

  14. Analgesia induced by morphine microinjected into the nucleus raphe magnus: effects on tonic pain.

    Science.gov (United States)

    Dualé, Christian; Sierralta, Fernando; Dallel, Radhouane

    2007-07-01

    One of the possible sites of action of the analgesic effect of morphine is the Nucleus Raphe Magnus, as morphine injected into this structure induces analgesia in transient pain models. In order to test if morphine in the Nucleus Raphe Magnus is also analgesic in a tonic pain model, 5 microg of morphine or saline (control) were microinjected into the Nucleus Raphe Magnus of the rat. Analgesic effects were assessed following nociceptive stimulation using transient heating of the tail (phasic pain) and subcutaneous orofacial injection of 1.5 % formalin (tonic pain). While morphine was strongly analgesic for the tail-flick response (p <0.0001 compared to control), analgesia on the response to formalin was also observed for both early (p = 0.007) and late responses (p = 0.02). However, the response to formalin was not completely blunted. These results suggest that the Nucleus Raphe Magnus is not the exclusive site of action of morphine-induced analgesia in clinical conditions.

  15. Circumplex Model of Affect: A Measure of Pleasure and Arousal During Virtual Reality Distraction Analgesia.

    Science.gov (United States)

    Sharar, Sam R; Alamdari, Ava; Hoffer, Christine; Hoffman, Hunter G; Jensen, Mark P; Patterson, David R

    2016-06-01

    Immersive virtual reality (VR) distraction provides clinically effective pain relief and increases subjective reports of "fun" in medical settings of procedural pain. The goal of this study was to better describe the variable of "fun" associated with VR distraction analgesia using the circumplex model (pleasure/arousal) of affect. Seventy-four healthy volunteers (mean age, 29 years; 37 females) received a standardized, 18-minute, multimodal pain sequence (alternating thermal heat and electrical stimulation to distal extremities) while receiving immersive, interactive VR distraction. Subjects rated both their subjective pain intensity and fun using 0-10 Graphic Rating Scales, as well as the pleasantness of their emotional valence and their state of arousal on 9-point scales. Compared with pain stimulation in the control (baseline, no VR) condition, immersive VR distraction significantly reduced subjective pain intensity (P anxiety, greater fun, greater presence in the VR environment, and positive emotional valence-were associated with subjective analgesia during VR distraction. Immersive VR distraction reduces subjective pain intensity induced by multimodal experimental nociception. Subjects who report less anxiety, more fun, more VR presence, and more positive emotional valence during VR distraction are more likely to report subjective pain reduction. These findings indicate VR distraction analgesia may be mediated through anxiolytic, attentional, and/or affective mechanisms.

  16. Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.

    Science.gov (United States)

    Ota, Takayo; Makihara, Masaru; Tsukuda, Hiroshi; Kajikawa, Ryuji; Inamori, Masayuki; Miyatake, Nozomi; Tanaka, Noriko; Tokunaga, Masahiro; Hasegawa, Yoshikazu; Tada, Takuhito; Fukuoka, Masahiro

    2017-06-01

    Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.

  17. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

    Science.gov (United States)

    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  18. The role of elastomeric pumps in postoperative analgesia in orthopaedics and factors affecting their flow rate.

    Science.gov (United States)

    Theodorides, Anthony Andreas

    2017-12-01

    Elastomeric pumps are mechanical devices composed of an elastomeric balloon reservoir into which the drug to be infused is stored, a protective casing (used by some manufacturers), a flow controller and a wound catheter. In orthopaedics they are used to provide continuous local infiltration analgesia. In this way patients rely less on other routes of analgesia and thus avoid their systemic side effects. Studies have shown good response to analgesia with these pumps for the first 24 hours but their benefit is not as clear at 48 and 72 hours. There are numerous factors that affect the flow rate of elastomeric pumps. Some are inherent to all elastomeric pumps such as: the pressure exerted by the elastomeric balloon, catheter size, the vertical height of the pump in relation to the wound, viscosity and partial filling. There are also other factors which vary according to the manufacturer such as: the optimal temperature to obtain the desired flow rate as this directly affects viscosity, the dialysate that the analgesic drug is mixed with (ie normal saline or 5% dextrose), and the storage conditions of the fluid to be infused. It is thus essential to follow the clinical guidelines provided by the manufacturer in order to obtain the desired flow rate. Copyright the Association for Perioperative Practice.

  19. Efficacy and tolerability of intravenous morphine patient-controlled analgesia (PCA) in women undergoing cesarean delivery.

    Science.gov (United States)

    Andziak, Marta; Beta, Jarosław; Barwijuk, Michal; Issat, Tadeusz; Jakimiuk, Artur J

    2015-06-01

    The aim of the study was to evaluate analgesic efficacy and tolerability of patient-controlled analgesia (PCA) with intravenous morphine. Our observational study included 50 women who underwent a Misgav-Ladach or modified Misgav-Ladach cesarean section. Automated PCA infusion device (Medima S-PCA Syringe Pump, Medima, Krakow, Poland) was used for postoperative pain control. Time of morphine administration or initiation of intravenous patient-controlled analgesia (IV PCA) with morphine was recorded, as well as post-operative pain at rest assessed by a visual analogue scale (VAS). All patients were followed up for 24 hours after discharge from the operating room, taking into account patient records, worst pain score at rest, number of IV PCA attempts, and drug consumption. Median of total morphine doses used during the postoperative period was 42.9mg (IQR 35.6-48.5), with median infusion time of 687.0 min. (IQR 531.0-757.5). Pain severity and total drug consumption improved after the first 3 hours following cesarean delivery (p PCA attempts per patient was 33 (IQR: 24-37), with median of 11 placebo attempts (IQR: 3-27). Patient-controlled analgesia with morphine is an efficient and acceptable analgesic method in women undergoing cesarean section.

  20. Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy

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    Vladimir Vrsajkov

    2018-03-01

    Full Text Available Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38 or standard postoperative analgesia (n = 38. First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6. Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0–10 in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g than in the standard analgesia group (270.2 ± 81.9 g (p = 0.000. Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy. Resumo: Justificativa e objetivo: Após a colecistectomia laparoscópica, os pacientes apresentam dor moderada no pós-operatório imediato. Alguns estudos mostraram

  1. Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Cave, Dominic; Duff, Jonathan; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita

    2016-09-01

    Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

  2. Continuous bilateral thoracic paravertebral blockade for analgesia after cardiac surgery: a randomised, controlled trial.

    Science.gov (United States)

    Lockwood, Geoff G; Cabreros, Leilani; Banach, Dorota; Punjabi, Prakash P

    2017-10-01

    Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg -1 .hr -1 ) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group. The primary outcome was morphine consumption at 48 hours using patient-controlled analgesia (PCA). Secondary outcomes included pain, respiratory function, nausea and vomiting. Serum lidocaine concentrations were measured on the first two post-operative days. There was no difference in morphine consumption or in any other outcome measure between the groups. Serum lidocaine concentrations increased during the study, with a maximum of 5.9 mg.l -1 . There were no adverse events as a consequence of the study. Bilateral paravertebral infusion of lidocaine confers no advantage over systemic lidocaine infusion after cardiac surgery. ISRCTN13424423 ( https://www.isrctn.com ).

  3. The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Dušica Simić

    2018-03-01

    Full Text Available Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects—from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment to an increase in the incidence of death due to the onset of the systemic inflammatory response. Peripheral blocks provide analgesia for 12–16 h, and are safer due to rare side effects that are easier to treat. The continuous peripheral block (CPNB has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff.

  4. Use of hydrotherapy during labour: Assessment of pain, use of analgesia and neonatal safety.

    Science.gov (United States)

    Mallen-Perez, Laura; Roé-Justiniano, M Teresa; Colomé Ochoa, Núria; Ferre Colomat, Alicia; Palacio, Montse; Terré-Rull, Carme

    2017-11-24

    To evaluate the effectiveness of the use of hydrotherapy in pain perception and requesting analgesia in women who use hydrotherapy during childbirth and to identify possible adverse effects in infants born in water. A multicentre prospective cohort study was performed between September 2014 and April 2016. A total of 200 pregnant women were selected and assigned to the hydrotherapy group (HG) or the control group (CG) according to desire and availability of use, data collection started at 5cm dilatation. The instruments used were the numerical rating scale (NRS), use of analgesia, Apgar Test, umbilical cord pH and NICU admission. Participants were distributed into: HG (n=111; 50 water birth) and CG (n=89). Pain at 30 and 90min was lower in the HG than in the CG (NRS 30min 6.7 [SD 1.6] vs 7.8 [SD 1.2] [Phydrotherapy reduces pain during labour, and during second stage in women who undergo a water birth and the demand for analgesia decreases in multiparous pregnant women. No adverse effects were seen in infants born under water. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  5. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study.

    Science.gov (United States)

    Boselli, E; Bouvet, L; Bégou, G; Dabouz, R; Davidson, J; Deloste, J-Y; Rahali, N; Zadam, A; Allaouchiche, B

    2014-04-01

    The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU. Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3. A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of 3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89. The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management. ClinicalTrials.gov NCT01796249.

  6. Effect of thrombocytopenia on mode of analgesia/anesthesia and maternal and neonatal outcomes.

    Science.gov (United States)

    Dikman, Daniel; Elstein, Deborah; Levi, Gal Schtrechman; Granovsky-Grisaru, Sorina; Samueloff, Arnon; Gozal, Yaacov; Ioscovich, Alexander

    2014-04-01

    The purpose was to correlate the use of regional analgesia/anasthesia among women with different degrees of thrombocytopenia relative to women with normal platelet counts, and note maternal and neonatal outcome, and mode of delivery. A case-control paradigm was developed based on women who delivered during 2007-2011 with platelet counts ≤80 000/mm(3). For each woman in this "severe" thrombocytopenic group, an age- and parity-matched control was found who delivered a singleton within the same year but whose platelets were either 81 000-150 000/mm(3) ("moderate" thrombocytopenia) or ≥151 000/mm(3) (normal platelet counts). 168 women were identified for each group; mean maternal age (28.4 years), mean gravidity (4.3), mean parity (3.7), mean gestational age (39.2 weeks) and mean birth weight (3283 g) were comparable. However, only in the severe thrombocytopenic women were there very early preterm deliveries, lowest birth weight, lowest Apgar scores, the greatest number with serious post-partum hemorrhage (>500 ml); use of regional analgesia/anesthesia was lowest, and percent cesarean sections highest. This study highlights potential for adverse maternal outcome of post-partum hemorrhage and adverse neonatal outcomes of prematurity, low birth weight, and low Apgar scores (but not neonatal death), and limited regional analgesia/anesthesia in women who present at delivery with severe (≤80 000/mm(3)) thrombocytopenia.

  7. Effect of Single Shot Intrathecal Sufentanil on Delivery Time and Analgesia in Nuliparae

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    E. Khoshraftar

    2008-04-01

    Full Text Available Introduction & Objective : The objective of this study was to determine the evaluation of intrathecal sufentanil for labor analgesia with respect to duration of labor stages and relief of pain during labor.Materials & Methods : In a clinical trial 60 subjects with ASA class I were selected and randomly divided in two equal groups. 30 subjects had received sufentanil 10 gr in 1 ml of saline during active phase of first stage of labor. The other group as controls, did not receive anything for analgesia. Parturient visual analog scale (VAS , HR, RR, BP, sensory and motor block, FHR and complications such as nausea, vomiting, pruritus and duration of stage I been monitored recorded and compared among those two groups.Results : Comparison of results in two groups have showed that sufentanil does not prolong the duration of labor in stage 1 and 2. We observed lack of hypotension and respiratory depression in sufentanil group FHR changes that had been associated with adverse neonatal out come had not occurred. The apgar scores in two groups were identical. There was itching in majority of parturient who had received sufentanil (83.3%. The pruritus were defined as mild and moderate. Conclusion : Intrathecal sufentanil provide a good analgesia in stage I labor and does not prolong the duration of labor with minimum adverse effects on parturient and fetus.

  8. preescolares desnutridos con madres con obesidad y sin obesidad

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    Viridiana Vanessa Conzuelo-González

    2009-01-01

    Full Text Available El primer objetivo fue conocer cuántos menores de cinco años con diferentes grados de desnutrición tienen una madre con sobrepeso/obesidad/ en una comunidad indígena que vive en extrema pobreza y bajo condiciones de migración masculina internacional. El segundo fue comparar tres variables socionutricionales (ingreso familiar, educación de la madre y adecuación nutrimental de la dieta diaria entre estos hogares y los hogares con desnutrición infantil y madres sin obesidad. Se realizó un estudio transversal (2006-2007, en la comunidad mazahua de San Francisco Tepeolulco, Municipio de Temascalcingo; que incluyó a 85 hogares integrados por preescolares con desnutrición inscritos al programa Oportunidades. Se determinó el estado nutrición de los preescolares con indicadores antropométricos y se obtuvo el IMC de las madres de estos infantes. Se aplicó una encuesta socionutricional, incluida el recordatorio de 24 horas, y complementado con la observación participante (cualitativa. Se encontró que 83% de las madres mazahuas presentaron sobrepeso u obesidad. El estado de nutrición de los preescolares con madres con obesidad presentó un porcentaje mayor de desnutrición (76%. En la variable género, se encontró que 54% de los niños con madres con obesidad tenía baja talla. Al relacionar el nivel educativo de la madre, esta variable resultó ser estadísticamente significativa (p=0.015, donde el analfabetismo está más relacionado con la desnutrición infantil que tienen madres de bajo y/o peso normal. La elevada prevalencia de hogares conformados con preescolares con desnutrición y madres con obesidad, es un síntoma más de la pobreza en zonas indígenas en México, con bajo índice de desarrollo humano.

  9. Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

    Directory of Open Access Journals (Sweden)

    Thaís Cristina Tebaldi

    2008-12-01

    ,5% (grupo CLON/HIPER; n = 11 o 2,5 mg de bupivacaína isobárica 0,5% (grupo CLON/ISO; n = 11 en asociación con el sufentanil 2,5 µg y la clonidina 30 µg. El dolor evaluado por la Escala Analógica Visual, la frecuencia cardíaca y la presión arterial promedio, fueron estudiados a cada 5 minutos en los primeros 15 minutos y a continuación, a cada 15 minutos hasta el nacimiento. Fue evaluada la prevalencia de efectos colaterales (náusea, vómito, prurito y sedación. El estudio fue terminado en el momento en que se hizo necesaria la complementación analgésica epidural (dolor > 3 cm o al nacimiento. El análisis estadístico fue realizado a través de los tests t de Student, Chi-cuadrado, Fisher y ANOVA de dos vías para medidas repetidas, considerando como significativo p BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (α-agonist prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesia¹. The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5% hyperbaric bupivacaine (CLON/HYPER Group; n = 11 or 2.5 mg of 0.5% isobaric bupivacaine (CLON/ISO Group; n = 11 associated with 2.5 µg of sufentanil and 30 µg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3 or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for

  10. Conservación de Soportes con Grabaciones Digitales por Medio de la Tecnología Óptica

    Directory of Open Access Journals (Sweden)

    Luis Ernesto Paz-Enrique

    2015-01-01

    Full Text Available La conservación documental garantiza la perdurabilidad de las fuentes y evita la restauración. Los soportes con grabaciones digitales por medio de la tecnología óptica (TO son los más empleados para el almacenamiento de información, paradójicamente son los menos abordados en investigaciones sobre preservación documental. En el estudio se emplea la Metodología de la Biblioteca Nacional de Cuba “José Martí” (BNJM para el diagnóstico de sedes y colecciones; aplicando las variables y describiendo los aspectos negativos detectados. Se diagnostica la Colección Multimedia de la Biblioteca Provincial “Martí” de Villa Clara. Se identifica que la colección de documentos analizada se encuentra en un alto riesgo de deterioro, de igual forma se identifican factores que a corto plazo pueden provocar la pérdida de información en los soportes. La situación de los documentos favorece la propuesta de un plan de medidas preventivas en correspondencia con la situación de la colección.

  11. Conductas sexuales de riesgo y actividades preventivas frente al cáncer de cuello uterino en mujeres universitarias vacunadas frente al VPH

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    Ana Fernández-Feito

    2018-05-01

    Full Text Available Resumen: Objetivo: Estimar la asociación entre la vacunación frente al virus papiloma humano (VPH y las conductas sexuales de riesgo, así como la participación en el Programa de Detección Precoz de Cáncer de Cuello Uterino (PDPCCU. Diseño: Estudio descriptivo transversal. Emplazamiento: Facultad de Medicina y Ciencias de la Salud, Facultad de Derecho y Facultad de Economía y Empresa (Universidad de Oviedo. Participantes: Estudiantes universitarias. Mediciones principales: Se recogió información sobre métodos anticonceptivos, conducta sexual, conocimientos sobre VPH y participación en el PDPCCU. Se estimaron proporciones y odds ratio (OR con sus correspondientes intervalos de confianza al 95% (IC 95%. Resultados: El 67,7% de la muestra estaban vacunadas frente al VPH. Un total de 216 mujeres (65,3% eran sexualmente activas. El 67,6% utilizaba un método de barrera en la relación actual, siendo menos frecuente entre las mujeres no vacunadas (54,9% frente al 75,4% en estudiantes vacunadas (p = 0,002. El riesgo de mantener al menos una conducta sexual de riesgo era mayor entre las mujeres no vacunadas: OR 2,29 (IC 95%: 1,29-4,07. La probabilidad de realizar una citología dentro del PDPCCU fue mayor entre las mujeres no vacunadas: OR 2,18 (IC 95%: 1,07-4,47. Conclusiones: La prevalencia de conductas sexuales de riesgo en mujeres no vacunadas es elevada y se relaciona con la no utilización de métodos de barrera. La vacunación frente al VPH puede influir en la conducta sexual y en la participación en PDPCCU. Se debería reforzar la información que reciben los jóvenes sobre anticoncepción, enfermedades de transmisión sexual y prevención del cáncer. Abstract: Aim: To estimate the association between the human papillomavirus (HPV vaccine and sexual risk behaviour, as well as the participation in the Cervical Cancer Screening Program (CCSP. Design: Cross-sectional study. Location: School of Medicine and Health Sciences

  12. Perioperative epidural analgesia reduces cancer recurrence after gastro-oesophageal surgery.

    Science.gov (United States)

    Hiller, J G; Hacking, M B; Link, E K; Wessels, K L; Riedel, B J

    2014-03-01

    Recent interest has focused on the role of perioperative epidural analgesia in improving cancer outcomes. The heterogeneity of studies (tumour type, stage and outcome endpoints) has produced inconsistent results. Clinical practice also highlights the variability in epidural effectiveness. We considered the novel hypothesis that effective epidural analgesia improves cancer outcomes following gastro-oesophageal cancer surgery in patients with grouped pathological staging. Following institutional approval, a database analysis identified 140 patients, with 2-year minimum follow-up after gastro-oesophageal cancer surgery. All patients were operated on by a single surgeon (2005-2010). Information pertaining to cancer and survival outcomes was extracted. Univariate analysis demonstrated a 1-year 14% vs. 33% (P = 0.01) and 2-year 27% vs. 40% [hazard ratio (HR)=0.59; 95% CI, 0.32-1.09, P = 0.087] incidence of cancer recurrence in patients with (vs. without) effective (> 36 h duration) epidural analgesia, respectively. Multivariate analysis demonstrated increased time to cancer recurrence (HR = 0.33; 95% CI: 0.17-0.63, P benefit (HR = 0.42; 95% CI: 0.21-0.83, P benefit in patients with oesophageal cancer (HR = 0.34; 95% CI: 0.16-0.75, P = 0.005) and in patients with tumour lymphovascular space infiltration (LVSI), (HR = 0.49; 95% CI: 0.26-0.94, P = 0.03). Effective epidural analgesia improved estimated median time to death (2.9 vs. 1.8 years, P = 0.029) in patients with tumour LVSI. This study found an association between effective post-operative epidural analgesia and medium-term benefit on cancer recurrence and survival following oesophageal surgery. A prospective study that controls for disease type, stage and epidural effectiveness is warranted. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

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    Mohamad MF

    2017-04-01

    Full Text Available Mohamad Farouk Mohamad,1 Montaser A Mohammad,1 Diab F Hetta,1 Eman Hasan Ahmed,2 Ahmed A Obiedallah,3 Alaa Ali M Elzohry1 1Department of Anesthesia, ICU and Pain Relief, 2Department of Clinical Pathology, South Egypt Cancer Institute, 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt Background and objectives: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methods: One hundred and twenty patients (American Society of Anesthesiologists grade II and III of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS. All patients were screened for occurrence of myocardial injury (MI by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT, pulmonary embolism, pneumonia, and death were recorded.Results: There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison

  14. Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

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    R. Azarfarin

    2006-05-01

    Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

  15. Mast cell deficiency attenuates acupuncture analgesia for mechanical pain using c-kit gene mutant rats.

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    Cui, Xiang; Liu, Kun; Xu, Dandan; Zhang, Youyou; He, Xun; Liu, Hao; Gao, Xinyan; Zhu, Bing

    2018-01-01

    Acupuncture therapy plays a pivotal role in pain relief, and increasing evidence demonstrates that mast cells (MCs) may mediate acupuncture analgesia. The present study aims to investigate the role of MCs in acupuncture analgesia using c-kit gene mutant-induced MC-deficient rats. WsRC-Ws/Ws rats and their wild-type (WT) littermates (WsRC-+/+) were used. The number of MCs in skin of ST36 area was compared in two rats after immunofluorescence labeling. Mechanical withdrawal latency (MWL), mechanical withdrawal threshold (MWT), and thermal withdrawal latency (TWL) were measured on bilateral plantar for pain threshold evaluation before and after each stimulus. Acupuncture- and moxibustion-like stimuli (43°C, 46°C heat, 1 mA electroacupuncture [EA], 3 mA EA, and manual acupuncture [MA]) were applied randomly on different days. Fewer MCs were observed in the skin of ST36 in mutant rats compared to WT rats ( P 0.05). Bilateral MWL and MWT in WsRC-+/+ rats increased significantly after each stimulus compared to baseline ( P <0.01, P <0.001). In WsRC-Ws/Ws rats, only noxious stimuli could produce anti-nociceptive effects for mechanical pain (46°C, 3 mA EA, MA) ( P <0.01, P <0.001). Additionally, the net increases in MWL and MWT induced by most stimuli were greater in WT than in mutant rats ( P <0.05). For thermal nociception, either high- or low-intensity stimuli could significantly augment TWL in two rats ( P <0.001), and the net increases of TWL evoked by most stimuli were to the same extent in two genetic variants. MCs influence the basic mechanical but not thermal pain threshold. MCs participate in acupuncture analgesia in mechanical but not in thermal nociception, in that MC deficiency may attenuate the mechanical analgesia evoked by high-intensity stimuli and eliminate analgesia provoked by low-intensity stimuli.

  16. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less.

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    Moore, Albert R; Shan, William Li Pi; Hatzakorzian, Roupen

    2013-01-01

    Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR) of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P analgesia (OR 0.780, P analgesia (P neonatal weight (OR 0.943, P analgesia. Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also associated with cesarean delivery.

  17. autorregulado con estudiantes universitarios

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    Jairo Andrés Montes

    2005-01-01

    Full Text Available El propósito del presente estudio es describir la forma en la que se presentan los procesos de aprendizaje autorregulado con un grupo de estudiantes (22 estudiantes de tercer semestre de Psicología de la PUJ, Cali, en el evento de preparación para la presentación un examen. Asimismo se describen las correlaciones que ocurren entre las distintas fases de dicho proceso de autorregulación del aprendizaje. Para conseguir los objetivos propuestos se ha hecho uso de una observación de desempeño en tiempo real, es decir, de la observación durante una sesión de preparación de examen de los estudiantes, en la cual se emplearon protocolos verbales para dar cuenta de lo que «pasaba por su mente» mientras estudiaban. Una entrevista semi-estructurada y una prueba objetiva. Los resultados fueron analizados a la luz del modelo mixto de procesamiento de información y constructivismo abordado por Winne(1998. Como resultado se encontró una relación significativa entre los niveles de desempeño en el proceso de ARR y el resultado del examen. Igualmente se encontraron bajos niveles de regulación en una parte importante de la muestra y un desfase significativo entre conocimiento declarativo de ARR y desempeño en el mismo

  18. Puentes con vigas pretensadas

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    Editorial, Equipo

    1965-07-01

    Full Text Available This paper describes one of the three bridges which Hidrocivil, S. A., has built in Catalonia (northern Spain, over the river Ripoll. The other two bridges are very similar to this one, both in construction and design, and show only minor adjustments to the local topography. The contracting firm proposed several alterations in the prefabrication and constructional procedure, in relation to the initial project, and these changes were accepted. The main feature of these projects is the use of prestressed beams, built at the workshop in sections, and joined together by means of sixty 7 mm cables in each beam. As the shear forces are more acute at the joints, the end of each section has a kind of diaphragm, to provide a large contact area, and hence greater surface to transmit the shear forces. The methods of construction are also of interest. Briefly, they involve building the bridge piles, and use these to support a provisional structure with transversal movement. This provisional structure, in turn, served as platform for two bridge cranes, which lifted the girders to their final location. After the first span was completed, the deck was concreted and the auxiliary structure pushed forward to the next span, to repeat the same operations. This arrangement saved the use of provisional framework.En este trabajo se describe uno de los tres puentes que Hidrocivil, S. A., ha construido.—previo concurso— en la región catalana; concretamente, el que salva el río Ripoll. Los otros dos no han sido objeto de descripción general por ser muy similares, en lo que a ejecución y concepción se refiere, con la única variante que presentan las características topográficas locales. La empresa propuso ciertas variantes— que fueron aceptadas— en la prefabricación y métodos de construcción. El interés de estas obras se centra en el empleo de vigas pretensadas, prefabricadas en taller por trozos, y solidarizados en el mismo mediante las operaciones

  19. Violencia con el anciano

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    Rita Campillo Motilva

    2002-08-01

    Full Text Available La violencia doméstica es tan antigua como la humanidad misma y se reconocen la violencia infantil, contra la mujer y al anciano, fundamentalmente; siendo este último grupo una población en ascenso por las mayores expectativas de vida de los últimos años. Como resultado de ello, el número de casos de abuso en el anciano se incrementará y el impacto de este abuso sobre la salud debe ser considerado de forma adecuada. La gama de maltratos es variadísima e incluye el abuso físico, emocional, financiero, sexual, por negligencia, negación a brindarle ayuda y otras formas más. Los ancianos con deterioro cognitivo son los más vulnerables. El médico en la atención primaria de salud es un pilar importante en la prevención y educación de este problema.Domestic violence is as old as humanity itself. Child, women and elderly abuse are mainly recognized. The elderly group is increasing due to the higher life expectancy experimented during the last years. As a result, the number of battered elderly will grow and the impact of this abuse on health should be adequately considered. The range of abuse is very wide and it includes physical, emotional, financial and sexual abuse, negligence, rejection to give assistance and others. The elderly with cognitive deterioration are the most vulnerable. The physician at the primary health care level is an important milestone in the prevention and education of this problem.

  20. Celulitis facial en niños con criterio de hospitalización

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    Dadonim Vila Morales

    Full Text Available Introducción: la celulitis facial puede convertirse en un grave riesgo vital cuando no se tiene en cuenta el tratamiento adecuado. Constituye un problema de salud en la población de edades pediátricas, pues es la segunda causa más frecuente de ingreso hospitalario en la cirugía maxilofacial, luego de los traumatismos maxilofaciales. Objetivo: describir el comportamiento y el manejo terapéutico por la Atención Primaria de Salud en los municipios de Playa, Marianao y Lisa de La Habana. Métodos: se realizó un estudio observacional retrospectivo en 53 pacientes que fueron ingresados en el Servicio de Cirugía Máxilo Facial del Hospital Pediátrico Docente "Juan Manuel Márquez", desde enero de 2001 a enero de 2007. Resultados: hubo ausencia de significación estadística entre sexos y entre los grupos de edades. La media de la edad fue de 8 años, con una desviación estándar de 4. La celulitis más frecuente fue la odontógena (60,4 %. El 60,3 % de los pacientes fueron mal manejados por la atención primaria. Los grupos dentarios más afectados sugieren que las acciones preventivas deben encaminarse mayormente a la población con dentición temporal y mixta. Conclusiones: hubo mayor representación del sexo masculino y del grupo de 1 a 5 años. El tipo de celulitis facial predominante fue la odontógena. En más de la mitad de los casos el tratamiento antimicrobiano aplicado en la atención primaria de salud fue inadecuado. Al momento del ingreso predominó la evaluación clínica severa.

  1. Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Li-zhong; CHANG Xiang-yang; LIU Xia; HU Xiao-xia; TANG Bei-lei

    2010-01-01

    Background Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine (Group B), ropivacaine (Group R) or levobupivacaine (Group L) with sufentanil 0.5 μg/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was ≤30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction (P >0.05). The relative median potency was bupivacaine/ropivacaine: 0.828 (0.602-1.091), bupivacaine/levobupivacaine: 0.845 (0.617-1.12), ropivacaine/levobupivacaine: 1.021 (0.774-1.354), respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of ≥0.1% within each group (P<0.05). Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine

  2. Diagnóstico educativo sobre salud bucal en embarazadas y madres con niños menores de un año

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    Judit Martínez Abreu

    Full Text Available Introducción: la atención estomatológica en Cuba prioriza a embarazadas y madres con niños menores de un año. Objetivo: identificar los conocimientos sobre salud bucal de embarazadas y madres con niños menores de un año. Métodos: se realizó un estudio observacional, descriptivo y transversal, en el municipio Matanzas de 2010 a 2012. El universo fueron todas las embarazadas y madres con niños menores de un año. Se seleccionó una muestra no probabilística con las primeras 126 gestantes captadas y 126 madres que acudieran a puericultura, que dieron su consentimiento informado. Se aplicó la encuesta de conocimientos del Programa Nacional de Atención Estomatológica Integral a la Población y una lluvia de ideas para identificar los conocimientos favorables o no a la salud bucal, en relación a cuatro temas: caries dental, periodontopatías, brote dentario y maloclusiones. Se consideró el nivel de conocimientos bajo (menos de 70 puntos, medio (entre 71 y 89 puntos y alto (más de 90 puntos. Los datos obtenidos fueron procesados estadísticamente, se usó el porcentaje como medida de resumen. Resultados: entre los conocimientos favorables a la salud bucal estuvieron los relacionados con las medidas preventivas de caries dental y periodontopatías, como el cepillado, con 85,7 % en embarazadas y 95,2 % en madres con niños menores de un año. Los conocimientos desfavorables fueron los relacionados con el brote dentario con 96 % en embarazadas y 94,4 % en madres con niños menores de un año. Las madres con niños menores de un año, mostraron nivel de conocimientos medio (70,6 %, mientras que las embarazadas, mostraron nivel bajo (65,9 %. Conclusiones: las madres con niños menores de un año mostraron nivel de conocimientos sobre salud bucal, medio y las embarazadas mostraron un nivel bajo. Los conocimientos sobre brote dentario y maloclusiones fueron insuficientes, por lo que serán las principales temáticas para desarrollar

  3. [A first step towards safer sedation and analgesia: A systematic evaluation of outcomes and level of sedation and analgesia in the mechanically ventilated critically ill patient].

    Science.gov (United States)

    Frade-Mera, M J; Regueiro-Díaz, N; Díaz-Castellano, L; Torres-Valverde, L; Alonso-Pérez, L; Landívar-Redondo, M M; Muñoz-Pasín, R; Terceros-Almanza, L J; Temprano-Vázquez, S; Sánchez-Izquierdo-Riera, J Á

    Safe analgesia and sedation strategies are necessary in order to avoid under or over sedation, as well as improving the comfort and safety of critical care patients. To compare and contrast a multidisciplinary protocol of systematic evaluation and management of analgesia and sedation in a group of critical care patients on mechanical ventilation with the usual procedures. A cohort study with contemporary series was conducted in a tertiary care medical-surgical ICU February to November during 2013 and 2014. The inclusion criteria were mechanical ventilation ≥ 24h and use of sedation by continuous infusion. Sedation was monitored using the Richmond agitation-sedation scale or bispectral index, and analgesia were measured using the numeric rating scale, or behavioural indicators of pain scale. The study variables included; mechanical ventilation time, weaning time, ventilation support time, artificial airway time, continuous sedative infusion time, daily dose and frequency of analgesic and sedative drug use, hospital stay, and ICU and hospital mortality, Richmond agitation-sedation scale, bispectral index, numeric rating scale, and behavioural indicators of pain scale measurements. Kruskal Wallis and Chi 2 , and a significance of p<.05 were used. The study included 153 admissions, 75 pre-intervention and 78 post-intervention, with a mean age of 55.7±13 years old, and 67% men. Both groups showed similarities in age, reason for admission, and APACHE. There were non-significant decreases in mechanical ventilation time 4 (1.4-9.2) and 3.2 (1.4-8.1) days, respectively; p= 0.7, continuous sedative infusion time 6 (3-11) and 5 (3-11) days; p= 0.9, length of hospital stay 29 (18-52); 25 (14-41) days; p= 0.1, ICU mortality (8 vs. 5%; p= 0.4), and hospital mortality (10.6 vs. 9.4%: p= 0.8). Daily doses of midazolam and remifentanil decreased 347 (227-479) mg/day; 261 (159-358) mg/day; p= 0.02 and 2175 (1427-3285) mcg/day; 1500 (715-2740) mcg/day; p= 0.02, respectively. There

  4. Uso del condón en hombres con parejas no estables en la Ciudad de México

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    Nieto-Andrade Benjamín

    1999-01-01

    Full Text Available Objetivo. Analizar la asociación de variables sociodemográficas en la utilización del condón durante prácticas sexuales vaginales con parejas no estables. Material y métodos. Los datos provienen de una encuesta probabilística sobre comportamiento sexual aplicada en 1992-1993 a una muestra de hogares en la Ciudad de México y su área conurbada. De 8 068 hombres de 15 a 60 años de edad que proporcionaron información, se seleccionaron 1 535 cuya última relación sexual -con penetración vaginal- había sido con una pareja no estable. Primero se realizó un análisis por componentes principales, para agrupar aquellas variables con dimensiones subyacentes comunes y, a partir de ellos y de algunas variables individuales, se efectuó una regresión logística. Resultados. Las variables que midieron conocimientos sobre el SIDA y sus mecanismos de transmisión y prevención, no tuvieron una relación estadísticamente significativa (p< 0.05 con haber usado condón en la última relación sexual vaginal con una pareja no estable (variable dependiente. En su lugar, las variables que sí presentaron una relación estadísticamente significativa con la variable dependiente, fueron: visión del placer del sexo con condón o sin penetración; autoeficacia para realizar sexo sin penetración; autocompulsión en el uso del condón asociado al SIDA como enfermedad de mayor temor; percepción sobre el carácter evitable de la infección y sobre la efectividad del condón; estado civil; escolaridad; y número de episodios de enfermedades de transmisión sexual (ETS en toda la vida. Conclusiones. Aunque la provisión de información es importante en las estrategias educacionales de prevención sobre VIH/SIDA, el fomento de una percepción individual y colectiva favorable (placentera sobre el condón, el sexo seguro y la autoeficacia para poner en práctica medidas preventivas contra la infección por VIH, puede ser de mayor importancia para adoptar el uso

  5. Maternal satisfaction as an outcome criterion in research on labor analgesia: data analysis from the recent literature.

    Science.gov (United States)

    Dualé, Christian; Nicolas-Courbon, Aurélie; Gerbaud, Laurent; Lemery, Didier; Bonnin, Martine; Pereira, Bruno

    2015-03-01

    To investigate whether maternal satisfaction (MS) is taken into consideration as an outcome criterion in clinical research on analgesia for labor. A systematic review of articles reporting analgesia for labor from a panel of 17 influential journals was undertaken. A total of 116 articles were analyzed, including 282 within-study groups. The scope of MS, the type of outcome measure used, and the time of measurement were noted. Each available observation was assigned an ordinal value of MS (ordMS), according to data distribution. The factors influencing ordMS were identified by multivariable analysis. The methods used to assess MS were very variable, even within the different measurement tools reported. The weighted distribution of ordMS was 17.8%, 21.8%, 31.2%, and 29.3% for levels "poor," "fair," "good," and "excellent," respectively. In comparative studies, statistical differences for analgesia were related to statistical differences for MS (Pvalue was high (0.87). Power to detect a difference in MS between treatment groups was low in general, but it influenced reporting of a significant difference for MS (Pinitial cervical dilatation, and the within-study percentage of nulliparous women. The techniques alternative to epidural analgesia negatively influenced ordMS. A standard and validated tool to assess MS in clinical research on analgesia for labor is still to be developed. Power should be improved by acting on sample sizes or sensitivity of the outcome.

  6. Involvement of spinal orexin A in the electroacupuncture analgesia in a rat model of post-laparotomy pain

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    Feng Xiao-Ming

    2012-11-01

    Full Text Available Abstract Background Orexin A (OXA, hypocretin/hcrt 1 is a newly discovered potential analgesic substance. However, whether OXA is involved in acupuncture analgesia remains unknown. The present study was designed to investigate the involvement of spinal OXA in electroacupuncture (EA analgesia. Methods A modified rat model of post-laparotomy pain was adopted and evaluated. Von Frey filaments were used to measure mechanical allodynia of the hind paw and abdomen. EA at 2/15 Hz or 2/100 Hz was performed once on the bilateral ST36 and SP6 for 30 min perioperatively. SB-334867, a selective orexin 1 receptor (OX1R antagonist with a higher affinity for OXA than OXB, was intrathecally injected to observe its effect on EA analgesia. Results OXA at 0.3 nmol and EA at 2/15 Hz produced respective analgesic effects on the model (P0.05. In addition, naloxone, a selective opioid receptor antagonist, failed to antagonize OXA-induced analgesia (P>0.05. Conclusions The results of the present study indicate the involvement of OXA in EA analgesia via OX1R in an opioid-independent way.

  7. Improving postoperative tonsillectomy pain management in children--a double blinded randomised control trial of a patient analgesia information sheet.

    Science.gov (United States)

    Bailey, Lucas; Sun, Jing; Courtney, Mark; Murphy, Paul

    2015-05-01

    To evaluate paediatric post-tonsillectomy pain management using oxycodone when a specific analgesia information sheet is included with standard postoperative information. Oxycodone information sheets were randomly allocated to half the study children's post-tonsillectomy information pack. The trial was double-blinded to the surgeon, anaesthetist, nursing and administrative staff. Parents and children completed the pain assessment on day 3, 5 and 7. On day 10 the parents completed a questionnaire. A postoperative analgesia information sheet provides for higher satisfaction and knowledge for parents using oxycodone (psheet, most significantly at day 3 and 7 post operatively (psheets are useful in education and use of postoperative analgesia. The primary objective to explore the efficacy of the information sheet has proved to be successful in this setting. Given risks of opioid analgesia, it is recommended that postoperative information sheets be given to all parents, to provide for improved analgesia control and safe management of children in the postoperative period. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery.

    Science.gov (United States)

    Baskan, Semih; Cankaya, Deniz; Unal, Hidayet; Yoldas, Burak; Taspinar, Vildan; Deveci, Alper; Tabak, Yalcin; Baydar, Mustafa

    2017-01-01

    This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

  9. Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

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    Jonathan B. Koea

    2009-01-01

    Full Text Available Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, =.06, less postoperative IV fluids (median 1200 mL versus 4300 mL, =.03 than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, =.05 and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, =.02. Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.

  10. Analgesia peridural para o trabalho de parto e para o parto: efeitos da adição de um opióide Effects of the association of an opioid with epidural analgesia for labor and delivery

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    José Guilherme Cecatti

    1998-07-01

    Full Text Available O objetivo deste estudo foi avaliar a eficácia e segurança da associação bupivacaína com sufentanil para a analgesia no trabalho de parto e do parto por meio de um bloqueio peridural contínuo. Realizou-se um ensaio clínico duplo-cego, prospectivo e aleatório, incluindo sessenta mulheres nulíparas da Maternidade do CAISM/UNICAMP. No momento da analgesia, as mulheres foram aleatoriamente alocadas em dois grupos: BS, recebendo 12,5 mg de bupivacaína com adrenalina mais 30 µg de sufentanil e BP, recebendo 12,5 mg de bupivacaína com adrenalina mais placebo. Foram avaliados os parâmetros relativos à qualidade e duração da analgesia, duração do trabalho de parto e também possíveis efeitos sobre o recém-nascido. Os resultados mostraram a superioridade da adição do sufentanil sobre o grau de analgesia durante o tempo de ação da primeira dose de anestésico local. Não houve aumento na duração do trabalho de parto depois do início da analgesia quando se compararam ambos os grupos, nem qualquer diferença quanto à via de parto. Não houve também diferenças entre os grupos com relação à avaliação dos recém-nascidos. Conclui-se que a associação de 30 µg de sufentanil à primeira dose de bupivacaína é segura e eficaz, melhorando a qualidade da analgesia, sua duração e não afetando a progressão do trabalho de parto e o resultado neonatal.The purpose of the present study was to evaluate the efficacy and safety of the association bupivacaine with sufentanil for labor and delivery analgesia through a continuous epidural blockade, for both mother and the neonate. A randomized double blind prospective clinical trial was performed including sixty nulliparous women at the Maternity of CAISM/UNICAMP. When requesting analgesia, the women were randomly allocated to two groups: BS, receiving 12.5 mg of bupivacaine with adrenaline plus 30 µg of sufentanil and BP, receiving 12.5 mg of bupivacaine with adrenaline plus placebo

  11. A ginástica terapêutica e preventiva chinesa Lian Gong/Qi Gong como um dos instrumentos na prevenção e reabilitação da LER/DORT

    Directory of Open Access Journals (Sweden)

    Gutembergue Livramento

    Full Text Available Este ensaio traz elementos da medicina ocidental, da medicina tradicional chinesa e da sociologia do trabalho para reflexão sobre o Qi Gong - exercícios terapêuticos, um dos pilares da Medicina Tradicional Chinesa (MTC - como importante meio de prevenção da LER/DORT e recuperação da saúde. Considerando a natureza interdisciplinar e diversos níveis de prevenção, aborda aspectos sociológicos sobre as condições de trabalho frequentemente relacionadas com este tipo de adoecimento e categorias de trabalhadores mais acometidos. Focaliza aspectos médicos sobre a LER/DORT e as Síndromes de Bloqueio na MTC, estabelecendo canais de articulação e contribuição entre esses campos de conhecimento sobre a saúde humana. Ressalta o Qi Gong como importante prática terapêutica e preventiva na MTC e sua adequação à LER/DORT. No âmbito do Qi Gong, focaliza o Lian Gong Shi Ba Fa - Lian Gong em 18 Terapias, já amplamente experimentado na China e divulgado, inclusive no Brasil, para tratar e prevenir síndromes de dor em região cervical, ombros, membros superiores, membros inferiores e região lombar. À guisa de conclusão, são apresentadas algumas reflexões sobre a propriedade e a importância do Qi Gong na reabilitação e na prevenção da LER/DORT.

  12. Estratégia de operações em serviços de saúde preventiva: análise dos critérios competitivos e recomendações operacionais

    Directory of Open Access Journals (Sweden)

    Lissandra Andréa Tomaszewski

    2016-01-01

    Full Text Available Resumo A crescente preocupação com a saúde tem levado ao aumento significativo da prática de esportes. Devido a isto, a área de fitness tem se inovado. Os gestores estão buscando soluções que atraiam cada vez mais adeptos para seus estúdios. A área de serviços tem crescido constantemente e o usuário é visto como parte deste serviço. Este trabalho analisa os critérios competitivos, pouco estudados na área de serviços, e realiza recomendações operacionais para serviços de saúde, tais como de fisioterapia, ginástica preventiva, pilates, entre outros. O intuito é auxiliar os gestores com um conjunto de recomendações de operações em serviços, como ter posicionamentos estratégicos em relação às instalações, às pessoas, aos equipamentos, ao material de comunicação, aos símbolos e ao preço. Os dados foram coletados, por meio de entrevistas pessoais, com 96 entrevistados na região do sul do Brasil. Foi realizada, primeiramente, a pesquisa exploratória qualitativa e, em seguida, a pesquisa quantitativa. Para análise estatística, foi utilizado o método de análise conjunta por meio do programa computacional SPSS18. Os resultados evidenciaram a ordem de importância dos cri